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TKR outcomes at NHS treatment center inferior to outcomes in other NHS hospitals
Compared to results at two National Health Service hospitals, a U.K. treatment center reported unsatisfactory 5-year survivorship and more revisions.
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Total knee replacement yielded better results when done in a single-surgeon setting than when patients were transferred from one center to another for surgery, according to a recent study.
“Patients benefit from a consistent treatment pathway which does not end within a year of surgery and with overall supervision by orthopaedic surgeons in substantive posts,” V. George Langkamer, FRCS, MD, at Weston General Hospital, North Somerset, United Kingdom, told Orthopaedics Today Europe.
The impetus for the study began when a U.K. National Health Service (NHS) treatment center opened adjacent to Weston General Hospital’s (WGH) traditional orthopaedic unit and hired surgeons from abroad to shorten the list of patients awaiting total knee replacement (TKR). The Weston NHS treatment center used the same Kinemax Plus TKR implant (Stryker; Berkshire, UK) and shared resources with the traditional unit, according to Langkamer.
Investigators at Weston General Hospital’s traditional orthopaedic unit will conduct long-term follow-up of the Kinemax Plus Knee arthroplasty implant..
Images: Langkamer VG
“We believed our department was performing in a satisfactory manner, despite the difficulties of working under the conditions created by the existence of the NHS Treatment Center in the same facility,” Langkamer said. “We felt the poor results reported from the treatment center did not reflect the results from our established orthopaedic department using the same implant.”
Langkamer and colleagues studied all 223 patients with TKR treated in 2004 in the WGH traditional unit. Results were compared with published results for the 258 patients sent from the Cardiff and Vale Orthopaedic Centre (CAVOC) in Wales to the NHS treatment center.
A subsequent study conducted at the CAVOC compared 258 patients with TKR treated locally at CAVOC (using a different prosthesis) to patients referred to the NHS treatment center at WGH.
At a mean of 5 years postoperatively, implant survivorship was 97.2% at WGH and 95% at CAVOC, but it was 80.6% at the NHS treatment center at WGH. According to Langkamer, the NHS treatment center revision rates were unusually high, with 44 patients having revisions compared to 12 patients at CAVOC and 6 patients at the WGH traditional unit. The 44 revisions at the treatment center were for infection (4), aseptic loosening (8), malalignment (11), instability (2), oversized components (3) and secondary patellar resurfacing (16). Five of six revisions at the WGH traditional unit were for aseptic loosening, one was for malalignment. The 12 revisions from CAVOC were for infection (4), malalignment (3), instability (2), and secondary patella resurfacing (3).
The mean Oxford Knee Scores at WGH and CAVOC were better than those from the NHS treatment center, Langkamer noted. A study limitation was the inability to standardize the clinical and radiographic review models by examining all patients at one site. Patients treated at the WGH traditional unit will be monitored long term to track any changes, Langkamer said. – by Jeff Craven
References:
- Hickey BA, Kempshall PJ, Metcalfe AJ, Forster MC. Review of Kinemax total knee replacements performed at the NHS treatment centre, Weston-Super-Mare: Five-year results. J Bone Joint Surg Br. 2012;94(4):510-516.
- Kempshall PJ, Metcalfe A, Forster MC. Review of Kinemax knee arthroplasty performed at the NHS Treatment Centre, Weston-Super-Mare. J Bone Joint Surg Br. 2009;91-B:229–233.
- Smith LK, Ahmad R, Langkamer VG. Kinemax knee arthroplasty in Weston-Super-Mare: Putting the record straight. Presented at the British Association for Surgery of the Knee Spring Meeting 2012. April 3-4. Derby, United Kingdom.
For more information:
- V. George Langkamer, FRCS, MD, can be reached at Grange Road, Uphill, Weston-Super-Mare, North Somerset, United Kingdom; email: lindsay.smith2@nhs.net.
Disclosures:
- Langkamer has no relevant financial disclosures.