QUALITY CONTROL IN HIP ARTHROPLASTY

Abstract

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for monitoring radiological outcome following total hip arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total hip arthroplasty operations. This included 1,143 procedures, the majority of which were undertaken by three Consultant Surgeons and four independent middle grade surgeons. The three Consultant Hip Surgeons assessed component position on post-operative weight-bearing anteroposterior pelvic/hip radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system. Weighted Kappa variance showed substantial interobserver (kappa = 0.60) and intraobserver reliability (kappa = 0.92). Our system comprised of only three ordinal scores, which were ‘good’ (score of 1), ‘acceptable’ (score of 2) and ‘poor’ (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was ‘good’. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat analysis of their radiological scores showed significant improvements for certain individual surgeons (Pearson-Chi Square p value 0.006)

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total hip arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to appraise trainees during their progression.