1
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Heckmann ND, Chung BC, Wier J, Liu KC, Mayfield CK, Lieberman JR. The Utility of Routine Postoperative Radiographs in the Asymptomatic Total Hip Arthroplasty Patient. J Arthroplasty 2022; 38:1070-1074. [PMID: 36535444 DOI: 10.1016/j.arth.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) patients often receive routine radiographs in the year following their index surgery. This study sought to investigate the clinical and economic value of obtaining routine postoperative hip radiographs for asymptomatic patients following primary elective THA. METHODS A retrospective cohort study of consecutive patients who underwent primary elective THA from 2016 to 2019 was conducted. Patients undergoing nonelective or revision THA, radiographic follow-up <10 months, and patients aged <18 years were excluded. All radiographs were reviewed for abnormalities in the first postoperative year by an arthroplasty fellowship-trained orthopaedic surgeon, blinded to the symptoms of the patient. RESULTS Of the 327 patients (351 hips) included, 57.2% were women and 68.2% were White, with an average age of 65 years (range, 22-97 years) and average body mass index of 29.1 kg/m2 (range, 16.2-49.8 kg/m2). Only four (0.4%) radiographic series revealed abnormalities with the potential to alter postoperative management. One patient experienced a change in management directly related to their abnormal finding (closed reduction for dislocation at 10.2 months postoperatively). The remaining three abnormal radiographic findings included femoral stem subsidence, progressive radiolucencies around an acetabular component, and cement mantle fracture. The average cost for each radiographic series was $155.27, resulting in total direct charges of $167,691.60. CONCLUSION Routine postoperative radiographs may be of limited utility in the asymptomatic patient in the first year following elective primary THA. Consideration should be given to limit postoperative radiographs following standard elective THA, while reserving postoperative radiographic evaluation for patients who are symptomatic. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Julian Wier
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Kevin C Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Cory K Mayfield
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
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2
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Meneghini RM. Techniques and Strategies to Optimize Efficiencies in the Office and Operating Room: Getting Through the Patient Backlog and Preserving Hospital Resources. J Arthroplasty 2021; 36:S49-S51. [PMID: 33785228 PMCID: PMC9758392 DOI: 10.1016/j.arth.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023] Open
Abstract
The effects of the coronavirus disease 2019 pandemic are pervasive and have decreased the volume of hip and knee arthroplasty procedures since the mandated cessation of elective surgical procedures at the height of the pandemic in early 2020. Therefore, a backlog of patients in need of these elective procedures is a probable consequence and increased productivity and efficiency in patient care delivery is essential now and into the future. This article outlines multiple strategies and techniques to develop and optimize efficiency in the hip and knee arthroplasty practice. Techniques for increasing surgical efficiency are detailed, along with perioperative strategies in the hospital, ambulatory surgery center, and office settings are outlined and discussed.
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Affiliation(s)
- R. Michael Meneghini
- Address correspondence to: R. Michael Meneghini, MD, Department of Orthopaedic Surgery, Indiana University Health Hip & Knee Center, Indiana University School of Medicine, 13100 East 136th Street, Suite 2000, Fishers, IN 46037
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3
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Rose A, Dures E, Smith LK. Hip and knee replacements: Should we follow them up? A survey of orthopaedic health professionals. Musculoskeletal Care 2020; 18:74-80. [PMID: 31925883 DOI: 10.1002/msc.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Alice Rose
- University of Bristol, Bristol, England, UK
| | - Emma Dures
- University of the West of England, Bristol, UK
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5
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Pritchard MG, Murphy J, Cheng L, Janarthanan R, Judge A, Leal J. Enhanced recovery following hip and knee arthroplasty: a systematic review of cost-effectiveness evidence. BMJ Open 2020; 10:e032204. [PMID: 31948987 PMCID: PMC7044879 DOI: 10.1136/bmjopen-2019-032204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To assess cost-effectiveness of enhanced recovery pathways following total hip and knee arthroplasties. Secondary objectives were to report on quality of studies and identify research gaps for future work. DESIGN Systematic review of cost-utility analyses. DATA SOURCES Ovid MEDLINE, Embase, the National Health Service Economic Evaluations Database and EconLit, January 2000 to August 2019. ELIGIBILITY CRITERIA English-language peer-reviewed cost-utility analyses of enhanced recovery pathways, or components of one, compared with usual care, in patients having total hip or knee arthroplasties for osteoarthritis. DATA EXTRACTION AND SYNTHESIS Data extracted by three reviewers with disagreements resolved by a fourth. Study quality assessed using the Consensus on Health Economic Criteria list, the International Society for Pharmacoeconomics and Outcomes Research and Assessment of the Validation Status of Health-Economic decision models tools; for trial-based studies the Cochrane Collaboration's tool to assess risk of bias. No quantitative synthesis was undertaken. RESULTS We identified 17 studies: five trial-based and 12 model-based studies. Two analyses evaluated entire enhanced recovery pathways and reported them to be cost-effective compared with usual care. Ten pathway components were more effective and cost-saving compared with usual care, three were cost-effective, and two were not cost-effective. We had concerns around risk of bias for all included studies, particularly regarding the short time horizon of the trials and lack of reporting of model validation. CONCLUSIONS Consistent results supported enhanced recovery pathways as a whole, prophylactic systemic antibiotics, antibiotic-impregnated cement and conventional ventilation for infection prevention. No other interventions were subject of more than one study. We found ample scope for future cost-effectiveness studies, particularly analyses of entire recovery pathways and comparison of incremental changes within pathways. A key limitation is that standard practices have changed over the period covered by the included studies. PROSPERO REGISTRATION NUMBER CRD42017059473.
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Affiliation(s)
- Mark G Pritchard
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jacqueline Murphy
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Wolfson Institute of Preventive Medicine - Barts and the London, Queen Mary University of London, London, UK
| | - Lok Cheng
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Roshni Janarthanan
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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6
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Judge A, Carr A, Price A, Garriga C, Cooper C, Prieto-Alhambra D, Old F, Peat G, Murphy J, Leal J, Barker K, Underdown L, Arden N, Gooberman-Hill R, Fitzpatrick R, Drew S, Pritchard MG. The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is limited evidence concerning the effectiveness of enhanced recovery programmes in hip and knee replacement surgery, particularly when applied nationwide across a health-care system.
Objectives
To determine the effect of hospital organisation, surgical factors and the enhanced recovery after surgery pathway on patient outcomes and NHS costs of hip and knee replacement.
Design
(1) Statistical analysis of national linked data to explore geographical variations in patient outcomes of surgery. (2) A natural experimental study to determine clinical effectiveness of enhanced recovery after surgery. (3) A qualitative study to identify barriers to, and facilitators of, change. (4) Health economics analysis to establish NHS costs and cost-effectiveness.
Setting
Data from the National Joint Registry, linked to English Hospital Episode Statistics and patient-reported outcome measures in both the geographical variation and natural experiment studies, together with the economic evaluation. The ethnographic study took place in four hospitals in a region of England.
Participants
Qualitative study – 38 health professionals working in hip and knee replacement services in secondary care and 37 patients receiving hip or knee replacement.
Interventions
Natural experiment – implementation of enhanced recovery after surgery at each hospital between 2009 and 2011. Enhanced recovery after surgery is a complex intervention focusing on several areas of patients’ care pathways through surgery: preoperatively (patient is in best possible condition for surgery), perioperatively (patient has best possible management during and after operation) and postoperatively (patient experiences best rehabilitation).
Main outcome measures
Patient-reported pain and function (Oxford Hip Score/Oxford Knee Score); 6-month complications; length of stay; bed-day costs; and revision surgery within 5 years.
Results
Geographical study – there are potentially unwarranted variations in patient outcomes of hip and knee replacement surgery. This variation cannot be explained by differences in patients, case mix, surgical or hospital organisational factors. Qualitative – successful implementation depends on empowering patients to work towards their recovery, providing post-discharge support and promoting successful multidisciplinary team working. Care processes were negotiated between patients and health-care professionals. ‘Good care’ remains an aspiration, particularly in the post-discharge period. Natural experiment – length of stay has declined substantially, pain and function have improved, revision rates are in decline and complication rates remain stable. The introduction of a national enhanced recovery after surgery programme maintained improvement, but did not alter the rate of change already under way. Health economics – costs are high in the year of joint replacement and remain higher in the subsequent year after surgery. There is a strong economic incentive to identify ways of reducing revisions and complications following joint replacement. Published cost-effectiveness evidence supports enhanced recovery pathways as a whole.
Limitations
Short duration of follow-up data prior to enhanced recovery after surgery implementation and missing data, particularly for hospital organisation factors.
Conclusion
No evidence was found to show that enhanced recovery after surgery had a substantial impact on longer-term downwards trends in costs and length of stay. Trends of improving outcomes were seen across all age groups, in those with and without comorbidity, and had begun prior to the formal enhanced recovery after surgery roll-out. Reductions in length of stay have been achieved without adversely affecting patient outcomes, yet, substantial variation remains in outcomes between hospital trusts.
Future work
There is still work to be done to reduce and understand unwarranted variations in outcome between individual hospitals.
Study registration
This study is registered as PROSPERO CRD42017059473.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew Judge
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Andrew Carr
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cesar Garriga
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Prieto-Alhambra
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- GREMPAL Research Group, Musculoskeletal Research Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jacqueline Murphy
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Barker
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lydia Underdown
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel Arden
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Rachael Gooberman-Hill
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sarah Drew
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark G Pritchard
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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7
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CORR Insights®: What is the Likelihood of Subsequent Arthroplasties after Primary TKA or THA? Data from the Osteoarthritis Initiative. Clin Orthop Relat Res 2020; 478:42-44. [PMID: 31663887 PMCID: PMC7000060 DOI: 10.1097/corr.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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8
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Smith LK, Dures E, Beswick AD. Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty. Orthop Res Rev 2019; 11:69-78. [PMID: 31308766 PMCID: PMC6613453 DOI: 10.2147/orr.s199183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives: Total hip arthroplasty (THA) is highly successful but national registries indicate that average age has lowered and that younger patients are at higher risk of revision. Long-term follow-up of THA was historically recommended to identify aseptically failing THA, minimising the risks associated with extensive changes, but follow-up services are now in decline. A systematic review was conducted to search for evidence of the clinical or cost-effectiveness of hip arthroplasty surveillance. Methods: The study was registered with PROSPERO International Prospective Register of Systematic Reviews and conducted according to PRISMA guidelines; databases included MEDLINE and Embase, and all studies were quality assessed. Original studies (2005 to 2017) reporting follow-up of adults with THA in situ >5 years were included. Researchers extracted quantitative and qualitative data from each study. Results: For eligibility, 4,137 studies were screened: 114 studies were included in the final analysis, representing 22 countries worldwide. Data extracted included study endpoint, patient detail, loss to follow-up, revisions, scores and radiographic analysis. Six themes were derived from inductive content analysis of text: support for long-term follow-up, subgroups requiring follow-up, effect of materials/techniques on THA survival, effect of design, indicators for revision, review process. Main findings-follow-up was specifically recommended to monitor change (eg asymptomatic loosening), when outcomes of joint construct are unknown, and for specific patient subgroups. Outcome scores alone are not enough, and radiographic review should be included. Conclusion: There were no studies directly evaluating the clinical effectiveness of the long-term follow-up of THA but expert opinions from a range of international authors advocated its use for defined subgroups to provide patient-centred care. In the absence of higher level evidence, these opinions, in conjunction with emerging outputs from the national joint registries, should be used to inform services for long-term follow-up of THA.
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Affiliation(s)
- Lindsay K Smith
- Department of Trauma and Orthopaedics, Weston Area Health NHS Trust, Weston-super-Mare, North Somerset, UK
| | - Emma Dures
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - AD Beswick
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
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9
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Reynolds B, Maister N, Gill SD, Waring S, Schoch P, Beattie S, Thomson A, Page RS. Identifying complications requiring re-operation following primary hip or knee arthroplasty: a consecutive series of 98 patients. BMC Musculoskelet Disord 2018; 19:91. [PMID: 29587713 PMCID: PMC5870822 DOI: 10.1186/s12891-018-2005-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of hip and knee arthroplasties completed is expected to double over the next decade. In public hospitals, regular post-arthroplasty orthopaedic review has commonly occurred for the duration of a patient's life, which requires substantial outpatient resources. However, there is limited evidence regarding the utility of these reviews for identifying complications. The current study investigated when and where complications requiring re-operation were identified following primary hip or knee arthroplasty. METHODS The medical records of all patients requiring re-operation for complications following primary hip arthroplasty (n = 48, 2004 to 2015) or knee primary arthroplasty (n = 50, 1998 to 2015) at a large regional health service were evaluated. Data were extracted by one of four investigators using a standardised electronic data extraction tool. Variables of interest included the health setting where the complication was initially identified, how long following the original operation the complication was identified and whether the complication was symptomatic. RESULTS Routine post-arthroplasty orthopaedic appointments identified 15 (15.3%) complications requiring re-operation; all were identified in the first-year post-surgery. For each complication identified in the first-year post-surgery, approximately 1000 orthopaedic outpatient appointments were required. After the first year, all complications were identified in Emergency Departments (n = 30, 30.6%), General Practice (n = 24, 24.5%) or non-routine orthopaedic outpatient appointments (n = 19, 19.4%). All patients with complications reported symptoms. CONCLUSIONS Routine post-arthroplasty review appointments were an inefficient mechanism for identifying complications requiring re-operation more than one year following surgery. Public health services should consider assessing and redesigning post-arthroplasty review services to reduce the burden on patients and the demand for outpatient appointments.
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Affiliation(s)
- Bill Reynolds
- Physiotherapy Department, Barwon Health, Geelong, VIC, 3220, Australia
| | - Nick Maister
- Orthopaedic Department, Barwon Health, Geelong, Victoria, 3220, Australia
| | - Stephen D Gill
- Physiotherapy Department, Barwon Health, Geelong, VIC, 3220, Australia. .,Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, VIC, 3220, Australia. .,School of Medicine, Deakin University, Waurn Ponds, VIC, 3220, Australia.
| | - Shaun Waring
- Orthopaedic Department, Barwon Health, Geelong, Victoria, 3220, Australia
| | - Peter Schoch
- Physiotherapy Department, Barwon Health, Geelong, VIC, 3220, Australia
| | - Sally Beattie
- Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, VIC, 3220, Australia
| | - Andrew Thomson
- Orthopaedic Department, Barwon Health, Geelong, Victoria, 3220, Australia
| | - Richard S Page
- Orthopaedic Department, Barwon Health, Geelong, Victoria, 3220, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, VIC, 3220, Australia.,School of Medicine, Deakin University, Waurn Ponds, VIC, 3220, Australia
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10
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Eneqvist T, Nemes S, Bülow E, Mohaddes M, Rolfson O. Can patient-reported outcomes predict re-operations after total hip replacement? INTERNATIONAL ORTHOPAEDICS 2018; 42:273-279. [PMID: 29299650 DOI: 10.1007/s00264-017-3711-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register. METHODS A total of 75,899 patients with THR due to osteoarthritis operated in 2002-2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C). RESULTS Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3-95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power. CONCLUSIONS Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.
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Affiliation(s)
- Ted Eneqvist
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden. .,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Szilárd Nemes
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Bülow
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Smith LK. A survey of the current state of hip arthroplasty surveillance in the United Kingdom. Musculoskeletal Care 2014; 12:232-238. [PMID: 25065760 DOI: 10.1002/msc.1077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Lindsay K Smith
- Orthopaedic Department, Weston General Hospital, Grange Road, Weston-s-Mare, North Somerset, BS23 4TQ
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12
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Marsh J, Hoch JS, Bryant D, MacDonald SJ, Naudie D, McCalden R, Howard J, Bourne R, McAuley J. Economic evaluation of web-based compared with in-person follow-up after total joint arthroplasty. J Bone Joint Surg Am 2014; 96:1910-6. [PMID: 25410510 DOI: 10.2106/jbjs.m.01558] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We previously demonstrated the feasibility and clinical effectiveness of a web-based assessment following total hip or total knee arthroplasty. The purpose of the present study was to conduct an economic evaluation to compare a web-based assessment with in-person follow-up. METHODS Patients who had undergone total joint arthroplasty at least twelve months previously were randomized to complete a web-based follow-up or visit the clinic for the usual follow-up. We recorded travel costs and time associated with each option. We followed patients for one year after the web-based or in-person follow-up evaluation and documented any resource use related to the joint arthroplasty. We conducted cost analyses from the health-care payer (Ontario Ministry of Health and Long-Term Care) and societal perspectives. All costs are presented in 2012 Canadian dollars. RESULTS A total of 229 patients (118 in the web-based group, 111 in the usual-care group) completed the study. The mean cost of the assessment from the societal perspective was $98 per patient for the web-based assessment and $162 per patient for the usual method of in-person follow-up. The cost for the web-based assessment was significantly lower from the societal perspective (mean difference, $-64; 95% confidence interval [CI], $-79 to $-48; p < 0.01) and also from the health-care payer perspective (mean difference, $-27; 95% CI, $-29 to $-25; p < 0.01). CONCLUSIONS The web-based follow-up assessment had a lower cost per patient compared with in-person follow-up from both societal and health-care payer perspectives.
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Affiliation(s)
- Jacquelyn Marsh
- Faculty of Health Sciences, Elborn College, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address for J. Marsh: . E-mail address for D. Bryant:
| | - Jeffrey S Hoch
- Centre for Excellence in Economic Analysis and Research, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address:
| | - Dianne Bryant
- Faculty of Health Sciences, Elborn College, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address for J. Marsh: . E-mail address for D. Bryant:
| | - Steven J MacDonald
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
| | - Douglas Naudie
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
| | - Richard McCalden
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
| | - James Howard
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
| | - Robert Bourne
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
| | - James McAuley
- London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: . E-mail address for D. Naudie: . E-mail address for R. McCalden: . E-mail address for J. Howard: . E-mail address for R. Bourne: . E-mail address for J. McAuley:
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Empirical support for radiographic review: a follow-up study of total hip arthroplasty. Hip Int 2014; 23:80-6. [PMID: 23233185 DOI: 10.5301/hip.2012.9912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
Routine post surgery surveillance of total hip arthroplasty (THA) is widely recommended to identify asymptomatic failure but inclusion of an x-ray adds to service costs. Evidence is needed to support orthopaedic opinion in order to identify what should be included in surveillance. An investigation was conducted to establish whether an x-ray is needed in addition to patient reported outcome measures. One hundred and fifty-four THA had been assessed at 3 years and were reviewed again at 6 to 9 years (mid-term) when radiographic signs of deterioration commonly appear. Data were explored for associations between radiographic changes and changes in the participants' Oxford Hip Score, age, EuroQol 5-D score or comorbidities. Hierarchical multiple regression analysis showed that the number of radiographic changes could not be predicted by any of the other variables. This supports the inclusion of an x-ray in THA surveillance and suggests that the state of the THA cannot be determined by the use of patient reported outcome measures alone. This has implications for future arthroplasty surveillance.
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Devane P, Horne G, Gehling DJ. Oxford hip scores at 6 months and 5 years are associated with total hip revision within the subsequent 2 years. Clin Orthop Relat Res 2013; 471:3870-4. [PMID: 23456189 PMCID: PMC3825899 DOI: 10.1007/s11999-013-2880-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Oxford hip score (OHS) is commonly reported in research studies as a reflection of pain and function but it is unclear whether it predicts subsequent prosthesis failure. QUESTIONS/PURPOSES We determined whether OHS obtained at 6 months and 5 years after surgery predicts risk of revision within the subsequent 2 years. METHODS We reviewed data from the New Zealand Joint Registry between January 1999 and December 2010. OHS at 6 months was available for 17,831 total hip patients. Patients were separated into four categories based on their OHS: 10,458 (59%) scored 42-48, 4726 (26%) scored 34-41, 1592 (9%) scored 27-33, and 1028 (6%) scored 0-26. Five-year OHSs were available for 3665 patients. Of these patients, 2619 (72%) scored 42-48, 657 (18%) scored 34-41, 225 (6%) scored 27-33, and 164 (4%) scored 0-26. RESULTS For patients with a 6-month OHS, revision risk within 2 years was 0.4% in the 42-48 group, 1.0% in the 34-41 group, 1.7% in the 27-33 group, and 6.2% in the 0-27 group. For patients with 5-year OHS, revision risk within 2 years was 0.3%, 1.1%, 3.6%, and 6.1%, respectively. Increase in revision risk for the 0-27 versus the 42-48 OHS group was 15-fold at 6 months and 18-fold at 5 years. CONCLUSIONS Our data suggest patients with an OHS of 42-48 at 6 months need a 5-year postoperative appointment. Those patients with a 5-year OHS of 42-48 need not be followed up for a further 5 years.
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Affiliation(s)
- Peter Devane
- Department of Orthopedics, CCDHB-Wellington Hospital, Riddiford Street, Wellington, New Zealand,
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15
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Merollini KM, Crawford RW, Whitehouse SL, Graves N. Surgical site infection prevention following total hip arthroplasty in Australia: a cost-effectiveness analysis. Am J Infect Control 2013; 41:803-9. [PMID: 23434381 DOI: 10.1016/j.ajic.2012.11.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/10/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is associated with substantial costs for health services, reduced quality of life, and functional outcomes. The aim of this study was to evaluate the cost-effectiveness of strategies claiming to reduce the risk of SSI in hip arthroplasty in Australia. METHODS Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP + ABC), and laminar air operating rooms (AP + LOR). A Markov model was used to simulate long-term health and cost outcomes of a hypothetical cohort of 30,000 total hip arthroplasty patients from a health services perspective. Model parameters were informed by the best available evidence. Uncertainty was explored in probabilistic sensitivity and scenario analyses. RESULTS Stopping the routine use of AP resulted in over Australian dollars (AUD) $1.5 million extra costs and a loss of 163 quality-adjusted life years (QALYs). Using antibiotic cement in addition to AP (AP + ABC) generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP + LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator. CONCLUSION Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalized patients, save lives, and enhance resource allocation. Based on this evidence, the use of laminar air operating rooms is not recommended.
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16
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Hall L, Halton K, Bailey E, Page K, Whitby M, Paterson D, Graves N. Post-discharge surgical site surveillance – where to from here? J Hosp Infect 2013; 84:268. [DOI: 10.1016/j.jhin.2013.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/23/2013] [Indexed: 10/26/2022]
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17
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The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract Res Clin Rheumatol 2013; 26:649-58. [PMID: 23218429 DOI: 10.1016/j.berh.2012.07.013] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarise the state of the literature evaluating the cost-effectiveness of elective total hip and knee arthroplasty (THA and TKA). METHODS We conducted a systematic review of published cost-effectiveness analyses of THA and TKA. To limit our search to high-quality published papers, we selected those papers included in the Cost-Effectiveness Analysis Registry (created by the Center for the Evaluation of Value and Risk in Health at Tufts University) and augmented the search with papers listed in PubMed. The data abstracted included incremental cost-effectiveness ratios, perspective of the analysis, time frame, sensitivity analyses conducted, and utility assessment. All cost-effectiveness ratios were converted to 2011 USD. RESULTS Seven studies presenting cost-effectiveness ratios for TKA and six studies for THA were included in our review. All economic evaluations of TKA were published between 2006 and 2012. By contrast, THA studies were published between 1996 and 2008. Out of the 13 studies evaluated in this review, four were from the societal perspective and eight were from the payer perspective. Five studies spanned the lifetime horizon. Of the selected studies, six used probabilistic sensitivity analysis to address uncertainty in data parameters. Both procedures have been shown to be highly cost-effective from the societal perspective over the entire lifespan. CONCLUSION THA and TKA have been found to be highly cost-effective in a number of high-quality studies. Further analyses are needed on the cost-effectiveness of alternative surgical options, particularly osteotomy. Future economic evaluations should address the expanding indications of THA and TKA to younger, more physically active individuals.
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Lieberman JR, Leger RR, Tao JC, Clohisy JC, Meneghini RM. Total hip arthroplasty surveillance: when do we see our patients postoperatively? J Arthroplasty 2011; 26:1161-4. [PMID: 21802255 DOI: 10.1016/j.arth.2011.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 04/22/2011] [Indexed: 02/01/2023] Open
Abstract
Despite the high volume of total hip arthroplasties (THAs) performed in North America, there is no consensus regarding postoperative implant surveillance. Therefore, an Internet survey of Hip Society members was performed to determine the timing of follow-up visits after THA. The surgeons were queried with respect to the time until the first and second postoperative visits and the interval of follow-up for the first and second decades. The average time until the first follow-up visit is 4.9 weeks, and 63% of patients are seen by 6 weeks after surgery. Ninety percent of respondents saw patients at 1 year after THA. Follow-up visits after year 1 were more variable. Guidelines for follow-up should be established to enhance patient outcomes over time.
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Affiliation(s)
- Jay R Lieberman
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
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19
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Fabi D, Levine B, Majoras N. Chronic renal failure and catastrophic failure of an acetabular component: a case report. J Bone Joint Surg Am 2011; 93:e68(1-4). [PMID: 21776542 DOI: 10.2106/jbjs.j.01262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David Fabi
- Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA
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Bellamy N, Wilson C, Hendrikz J, Whitehouse SL, Patel B, Dennison S, Davis T. Osteoarthritis Index delivered by mobile phone (m-WOMAC) is valid, reliable, and responsive. J Clin Epidemiol 2010; 64:182-90. [PMID: 20609562 DOI: 10.1016/j.jclinepi.2010.03.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 03/01/2010] [Accepted: 03/29/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the validity, reliability, responsiveness, and mode preference of electronic data capture (EDC) using the Western Ontario and McMaster (WOMAC) numerical rating scale (NRS) 3.1 Osteoarthritis (OA) Index on Motorola V3 mobile phones. STUDY DESIGN AND SETTING Patients with OA undergoing hip or knee joint replacement were assessed preoperatively and 3-4 months postoperatively, completing the WOMAC Index in paper (p-WOMAC) and electronic (m-WOMAC) format in random order. RESULTS Data were successfully and securely transmitted from patients in Australia to a server in the United States. Pearson correlations between the summated total index scores (TISs) for the p-WOMAC and m-WOMAC pre- and postsurgery were 0.98 and 0.99 (P<0.0001). There were no clinically important or statistically significant between-method differences in the adjusted total summated scores, pre- and postsurgery (adjusted mean differences=4.44, P=0.474 and 1.73, P=0.781, respectively). Internal consistency estimates of m-WOMAC reliability were 0.87-0.98. The m-WOMAC detected clinically important, statistically significant (P<0.0001) improvements in pain, stiffness, function, and TIS. No statistically significant differences in mode preference were detected. CONCLUSIONS There was close agreement and no significant differences between m-WOMAC and p-WOMAC scores. This study confirms the validity, reliability, and responsiveness of the Exco InTouch-engineered, Java-based m-WOMAC Index application. EDC with the m-WOMAC Index provides unique opportunities for using quantitative measurement in clinical research and practice.
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Affiliation(s)
- Nicholas Bellamy
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland 4006, Australia.
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Hacking C, Weinrauch P, Whitehouse SL, Crawford RW, Donnelly WJ. Is there a need for routine follow-up after primary total hip arthroplasty? ANZ J Surg 2010; 80:737-40. [DOI: 10.1111/j.1445-2197.2010.05346.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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