Kingsbury S R, Dube B, Thomas C M, Conaghan P G, Stone M H
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
Bone Joint J. 2016 Feb;98-B(2):201-8. doi: 10.1302/0301-620X.98B2.36424.
Increasing demand for total hip and knee arthroplasty (THA/TKA) and associated follow-up has placed huge demands on orthopaedic services. Feasible follow-up mechanisms are therefore essential.
We conducted an audit of clinical follow-up decision-making for THA/TKA based on questionnaire/radiograph review compared with local practice of Arthroplasty Care Practitioner (ACP)-led outpatient follow-up. In all 599 patients attending an ACP-led THA/TKA follow-up clinic had a pelvic/knee radiograph, completed a pain/function questionnaire and were reviewed by an ACP. An experienced orthopaedic surgeon reviewed the same radiographs and questionnaires, without patient contact or knowledge of the ACP's decision. Each pathway classified patients into: urgent review, annual monitoring, routine follow-up or discharge.
In total, 401 hip and 198 knee patients were included. There was substantial agreement between the ACP and surgeon for both hip (kappa = 0.69, 95% confidence interval (CI) 0.62 to 0.76) and knee (kappa = 0.81, 95% CI 0.74 to 0.88). Positive agreement was very high for discharge and routine follow-up; however the ACP was more likely to select annual monitoring and the surgeon urgent review.
Review of the questionnaire/radiograph together identified all patients in need of increased surveillance, with good agreement for on-going patient management. However, review of the radiograph or questionnaire alone missed some patients with potential problems. A radiograph in conjunction with a questionnaire as a review may represent a cost effective THA/TKA follow-up mechanism.
A questionnaire and radiograph-based remote review may represent a cost-effective total joint arthroplasty follow-up mechanism; thereby reducing the considerable burden that follow-up currently places on the NHS.
对全髋关节置换术（THA）和全膝关节置换术（TKA）的需求不断增加，以及相关的随访工作给骨科服务带来了巨大压力。因此，可行的随访机制至关重要。
我们基于问卷/放射照片审查，对THA/TKA的临床随访决策进行了审核，并与由关节置换护理从业者（ACP）主导的门诊随访的当地做法进行了比较。在所有599名参加由ACP主导的THA/TKA随访门诊的患者中，均拍摄了骨盆/膝关节X光片，填写了疼痛/功能问卷，并由ACP进行了评估。一位经验丰富的骨科医生在不接触患者或不了解ACP决策的情况下，对相同的X光片和问卷进行了评估。每条路径将患者分为：紧急复查、年度监测、常规随访或出院。
总共纳入了401例髋关节患者和198例膝关节患者。ACP和外科医生在髋关节（kappa = 0.69，95%置信区间（CI）0.62至0.76）和膝关节（kappa = 0.81，95%CI 0.74至0.88）方面都有很高的一致性。出院和常规随访的肯定一致性非常高；然而，ACP更倾向于选择年度监测，而外科医生更倾向于紧急复查。
问卷/放射照片的联合审查共同识别出了所有需要加强监测的患者，在持续的患者管理方面具有良好的一致性。然而，单独审查放射照片或问卷会遗漏一些有潜在问题的患者。结合问卷的放射照片审查可能是一种具有成本效益的THA/TKA随访机制。
基于问卷和放射照片的远程审查可能是一种具有成本效益的全关节置换术随访机制；从而减轻目前随访给英国国家医疗服务体系（NHS）带来的巨大负担。
