In the current economic climate there is increasing pressure to identify cost-saving measures across the NHS. Our recent work suggests that many centres are curtailing primary hip and knee arthroplasty follow-up services to deal with the growing pressure on their services. However, such disinvestment is without evidence-base and raises questions of the consequences to patients. This project will examine the requirements for arthroplasty follow-up and produce evidence and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Work packages 1-3 will be discrete research projects, conducted independently. However, knowledge and information from each will feed into and inform the other work streams with some tasks being conducted in parallel.
Literature searches will be designed in accordance with guidance for qualitative evidence synthesis, systematic reviews, cost-effectiveness reviews and rapid reviews. They will identify published and unpublished papers, dissertations, conference abstracts and ongoing research in follow-up care pathways for primary knee arthroplasty
WP2a (RO-HES) is a retrospective cohort study using routinely collected (observational) NHS data from:
Data from these sources will be linked to construct longitudinal records for analysis.
For more information on the data that will be used click here
National linked datasets CPRD-HES, and NJR-HES-PROMS
These routine data from national datasets will be analysed to determine when revision happens to inform when follow-up should occur identify patients most likely to require revision to target who should be followed-up.
Large datasets from the NJR alongside data from NHS Digital will be used during this study. The personal identifiers of patients who had hip or knee replacement surgery and consented for their details to be stored in the NJR will be securely transferred to NHS Digital. NHS Digital will link the data to information it collects and extract details of all hospital admissions (HES) for the study cohort and Patient Recorded Outcome Measures (PROMS). NHS Digital will securely transfer the linked data to the University of Oxford as pseudonymised data (i.e. all identifiers will be removed and replaced with a unique patient ID). The NJR will securely transfer pseudonymised information from its records to the University of Oxford using the same unique ID so that the data can be linked by the University of Oxford and processing in such a way that researchers will not be able to identify patients.
Access patient information, and the NJR study website.
After a hip or knee replacement, some patients are offered a periodic check-up (referred to as ‘follow up’) and others are not. It is not known if this will make any difference to the outcome of knee or hip replacement surgery. This research will investigate if individual patient-centred follow-up can better identify potential problems, to the benefit of all concerned.
The aims of WP3 are to determine how follow-up should occur by:
Evidence from WP1-3 will feed into a consensus panel, using the NICE Guideline development model, involving 25-30 participants including patients, surgeons, GPs, and commissioners. The output will be a policy document which includes a stratification algorithm for appropriate follow-up for an individual patient.
Funding acknowledgement: The project UK SAFE project was funded by the NIHR HS&DR (project ref: 14/70/146)
Department of Health disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Lema Vernon, Osteoarthritis Trial Coordinator & UK SAFE Project Manager
Tel: +44 (0)113 392 4990