Introduction

Local commissioning groups are no longer funding outpatient follow up of joint replacements in an effort to save money. We present the costs of changing from traditional follow up methods to a virtual clinic at Warwick Hospital. Before September 2014 all joint replacements were seen in outpatients at six weeks, one year, five years, ten years and then every two years thereafter. They were usually reviewed, in a non-consultant led clinic, by a Band 7 specialist physiotherapist. This cost approximately £50 per patient including x-ray. Occasionally, the patients were seen in a consultant led clinic costing approximately £100.

Introduction: Disagreement exists in the literature as to whether hip resurfacing requires more acetabular reaming than uncemented hip replacement.

Materials and Methods: Thirty-nine patients underwent total hip arthroplasty with a large metal on metal resurfacing acetabular cup and large metal head with a conventional uncemented femoral stem. Although there was no change in routine operative technique the femoral neck was measured (as if for resurfacing) before being cut. The size of the acetabular component actually inserted was compared with the smallest size which could have been used had a resurfacing been carried out for each patient. A two tailed paired t test was carried out.

Results: We found that there was no difference in female patients but in men the actual cup used was 2.44mm smaller than the smallest possible resurfacing cup which equates to 6.39cm³ less bone (p < 0.0001).

Discussion: By using paired samples we have reduced confounding factors and shown that a large metal on metal bearing on a conventional stem is more conservative of acetabular bone than hip resurfacing in male patients.

Background: There has been much interest recently in reducing the length of inpatient stay after hip and knee arthroplasty and much of the relevant literature has linked this to minimally invasive surgery. Orthopaedic departments are often under great pressure to reduce inpatient stay in order to increase throughput of patients. However it is incumbent on those of us responsible for patient care to ensure that systems are in place to maintain safety.

Patients and Methods:We looked at a 6 month period of early discharge with a dedicated ‘Accelerated Discharge Team’ (A.T.T.) at our institution. The team consisted of three nurses, two physiotherapists and two ‘technical instructors’. All patients undergoing hip or knee arthroplasty were assessed pre-operatively and post-operatively for admission to the care of the A.T.T. against fixed criteria. Patients were visited at home on the day of discharge and every day until released from the care of the team. 333 patients underwent lower limb arthroplasty during the study period of which 305 (91.6%) were admitted to the care of the A.T.T.

Results: The mean lengths of stay for primary hip and knee replacements were 3.43 and 3.30 days respectively. The mean for revision hip and knee were 5.75 and 3.29 days respectively. 66% (95% C.I. 57%–74%) of patients undergoing primary hip arthroplasty went home by 3 days and 91% (95% C.I. 85%–95%) by 4 days. 73% (95% C.I. 64%–81%) of patients undergoing total knee arthroplasty went home by 3 days and 93% (95% C.I. 87%–97%) by 4 days. The most common reasons for delay were: social reasons or living alone; low blood pressure or haemoglobin level; difficulty walking. Of the 305 patients, 12 (4%) were readmitted to hospital within 6 weeks of discharge, 2 of these patients (1%) were still under the care of the A.T.T. Almost 90% of patients responded to a satisfaction survey. 94.2% of those responding indicated that they would use the A.T.T. scheme again.

Discussion: Other authors have linked early discharge to minimally invasive surgery or to special anaesthetic/ analgesic techniques. It has also been shown that both carepathways and patient education protocols can reduce length of stay. In the year before implementing the A.T.T. the mean stay for primary hip and knee replacements was over 9 days. We were able to reduce this to less than 3.5 days for over 90% of our patients during the study period. This was achieved safely and without any special surgical or anaesthetic techniques. The total cost of the scheme was just under £100 000 for the 6 month period. We estimate that 2000 bed days were saved during the same period. This is cost effective on these terms alone. As well as transferring 12 elective orthopaedic beds to a different department we were able to perform an estimated 75 extra lower limb arthroplasties in the 6 month period.

Aim To review 6 months of early discharge with a dedicated ‘Accelerated Discharge Team’ (A.T.T.) at our institution.

Patients and Methods The team consisted of four nurses and three physiotherapists. Patients undergoing hip or knee arthroplasty were assessed pre-operatively and post-operatively for admission to the care of the A.T.T. against fixed criteria. Patients were visited at home on the day of discharge and every day until released from the care of the team. 333 patients underwent lower limb arthroplasty during the study period of which 305 (91.6%) were admitted to the A.T.T.

Results The mean length of stay for primary knee replacements was 3.30 days. 73% (95% C.I. 64%–81%) of patients undergoing total knee arthroplasty went home by 3 days and 93% (95% C.I. 87%–97%) by 4 days. Results for hip arthroplasty were similar. Of the 305 patients, 12 (4%) were readmitted to hospital within 6 weeks of discharge. Almost 90% of patients responded to a satisfaction survey. 94.2 % of those responding indicated that they would use the A.T.T. scheme again.

Discussion In the year before implementing the A.T.T. the mean stay for primary hip and knee replacements was over 9 days. We reduced this to less than 3.5 days for over 90% of our patients during the study period. The total cost of the scheme was just under £100 000 for the 6 month period. We estimate that 2000 bed days were saved during the same period. This is cost effective on these terms alone. As well as transferring 12 elective orthopaedic beds to a different department we were able to perform an estimated 75 extra lower limb arthroplasty operations in the 6 month period.

Aims: To study clinical outcome of patients treated with a new design of the patellar tendon-tibial tubercle graft, which has reliable stability for transfer in recurrent dislocation of patella. Methods: 22 dislocations in 19 patients (3 bilateral) operated by this new technique were reviewed. There were 14 female and 5 male patients. Indications for surgery included functional disability due to repeated dislocations and failure of conservative management. Average age of the patient: 26 years (15–39 years). Duration of follow-up: 12–88months. Demographic data was collected by reviewing the case notes. Postoperative evaluation based on subjective pain evaluation score and Lysholm knee score. Surgical approach: limited infrapatellar midline incision, no internal fixation in any of the cases. Results: 75% of the patients had excellent to good result. There was no recurrence of instability/dislocation in any of the cases. Fair & poor (25%) results were graded based on stiffness and pain Conclusions: Multiple surgical procedures have been described for the management of recurrent dislocation of patella ranging from soft tissue realignment to bony procedures with internal fixation. Our results showed good functional improvement in the majority of the patients. This procedure is less extensive compared to the original procedure. Also there is the added advantage of no internal fixation and hence a second surgery for the removal of the implant can be avoided.