The Scottish Arthroplasty Project

Information for Patients

Results from the Scottish Arthroplasty Project - what do they mean for you?
Explanation of Complications
Revision Surgery
Infection
Dislocation
What the Artroplasty Project does about complications
Death
Information about hip and knee surgery
Useful patient information sites
Poster for Orthpaedic Units

Results from the Scottish Arthroplasty Project - what do they mean for you?
The Scottish Arthroplasty Project reports back to the orthopaedic community and the public through the production of latest national report and other 'one off' reports. The annual report includes information about how many hip and knee replacements are carried out each year, how many operations surgeons are performing per year, and information about the number of patients experiencing complications following their hip or knee surgery (an explanation of why a patient might encounter complications is included below). Any consultant or team whose results were unusual in any way have been contacted and asked to review their results. (see clinical governance pages of this website)

Explanation of Complications
Orthopaedic surgeons are keen to avoid these outcomes but there is always a risk. Sharing data helps to improve their practice by sharing knowledge.


Revision Surgery
Revision surgery (where the existing artificial joint needs to be replaced) is either carried out soon after the initial joint replacement (usually because the patient is having problems with infections or dislocations) or a number of years later (when the joint has worn out). Revisions carried out soon after the initial operation are rare and would be classed as a complication whereas revisions a number of years later are quite normal.

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Infection
Infection of a joint replacement can be difficult and disabling, requiring antibiotics and perhaps more surgery and a further stay in hospital. While orthopaedic surgeons make every effort to avoid this happening, unfortunately it can still occur in a few cases. The bacteria causing an infection can come from the patient's own skin, or may come from somewhere else, perhaps the operating theatre or the ward. To avoid infection occurring in the hospital, orthopaedic departments:
•  have strict procedures;
•  special operating theatres;
•  give patients antibiotics during the operation; and
•  use special techniques during surgery.

Although a lot of care is taken to prevent patients getting an infection, some patients are more likely to suffer from an infection than others. For example, patients whose disease or treatment affects their immune system:
•  Patients suffering from Rheumatoid arthritis;
•  Patients taking steroids; and
•  Patients receiving kidney dialysis.
Patients who have an infection that they have had for a long time (known as a ‘chronic' infection, such as a long term urinary tract infection or leg ulcers), also have a higher chance of their joint replacement becoming infected. For these patients, it is important to try and clear up the infection before surgery.

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Dislocation
Dislocation after having a knee replacement is rare, but it is the commonest complication after a hip replacement. This tends to be a painful setback rather than a disaster and often something can be done about it. Some hip replacement patients are much more likely to suffer from a dislocation than others. These include:
•  those patients whose hips were dislocated before they had surgery;
•  those patients who have revision surgery; and
•  those patients who have surgery following a fracture.

What the Arthroplasty Project Does About Complications
If we compared the number of patients each surgeon had treated who went on to develop a complication, surgeons treating patients who are at higher risk of complications would look to be worse than other surgeons. This could lead to surgeons not carrying out surgery on high risk patients. Instead the arthroplasty project takes risk factors into account (e.g. age, gender, fheumatoid arthritis) when working out whether a surgeon has a higher than expected number of complications. These surgeons are then asked to take action to correct any problems that are identified.

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Death
Death following planned joint replacement surgery is fortunately extremely rare. While SAP does present graphs showing the number of patients who have died in each NHS Board, it does not investigate these deaths in detail. These should be investigated locally by the department concerned.

Information about hip and knee surgery
Listed below are some useful links to websites that contain information for patients about hip and knee replacement surgery. Details about how to prepare for surgery and the treatment that you receive after surgery will differ slightly between hospitals, so please ask the health professionals who will be responsible for your care for more specific information.

Useful patient information sites:

http://www.arthritiscare.org.uk
This website provides useful information about arthritis

http://www.newtotaljoints.info/
This website provides a great deal of patient information about arthroplasty.

Poster for orthopaedic units

The Scottish Arthroplasty Project. The Scottish Arthroplasty Project Patient Information Poster

As the Scottish Arthroplasty Project uses named patient information, it is vital that patients are aware of the Project and understand what their information is being used for. The poster above should be prominently displayed in all orthopaedic departments that participate in the arthroplasty project.

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