The Scottish Arthroplasty Project has been under review recently. Although it has been decided that the Project is to continue, the hiatus in the review period means that 2011 information will now be summarised in next year's 2012 report rather than published separately. Regular data and information will still be published on the Scottish Arthoplasty Project website.
In 2010 we started using CUSUM methodology to allow us to identify unusual runs of complications more quickly. See CUSUM information for more details.
Consultant outliers were contacted for the first time in June 2010, and have provided good feedback for the more up-to-date information. Early Revision outliers will be contacted for the first time in November 2010.
There were 7,168 hip replacements and 6,884 knee replacements recorded in 2009. The number of hip revisions (986) and knee revisions (567) have continued to rise. Shoulder and finger arthroplasties also continue to increase (405 and 77 respectively..— see Table 2).There continues to be an increase in the number of primary hip and knee replacements performed at Golden Jubilee National Facility, with 930 hip and 1085 knee replacements in 2009 (see page 6). Recording of NHS funded arthroplasties performed at independent hospital has improved for 2009, with only a small number of cases now considered missing.
The number of low volume surgeons continued to decrease in 2009. Less than 10% of primary knee replacements and fewer than 30% of knee revisions are now performed by low volume surgeons.
The length of stay for hip replacements continues to fall year on year. It has decreased from an average of 10.3 days in 2001 to 6.2 days in 2009. The length of stay for knee replacements has decreased from 10.1 days in 2001 to 6.5 days in 2009. The proportion of patients admitted on the day of surgery increased significantly from 28% in 2008 to 35% in 2009. There is still, however, large variation between Health Boards in the time of admission before surgery.
The rate of DVT/PE (1%) and mortality (0.4%) at 90 days after hip arthroplasty are now at their lowest level ever. The rate of dislocation and infection within a year of hip arthroplasty do not differ greatly from recent years. Rates for infection, DVT/PE and deaths following knee replacement also remain consistent with recent years.
Complications such as stroke, acute myocardial infarction, and acute renal failure also continue to be included in the Report.
This year, for the first time, revision rates are reported at 1, 3 and 5 years following primary hip and knee replacement. Revision rates at 1 and 3 years for hips and knees were lowest in 2005. There has been a small increase in revision rate since then.There was less variation between boards for knee revisions at 1 year compared to hip revisions. This may be due to a more uniform design of knee prostheses compared to hip prostheses.