Fast-track assessment clinic: selection of patients for a one-stop hip assessment clinic.
BACKGROUND
The fast-track assessment clinic (FTAC) is a process to select patients who are very likely to require primary total hip replacement. Selected patients can then be seen in a one-off clinic reducing the number of hospital visits, cost to primary care trusts and delay between referral and treatment.


METHODS
Fifty patients on the waiting list for hip replacement were analysed to see if there were common parameters that led to their inclusion. From these data, fast-track selection criteria (FTSCs) were generated. These FTSCs were used to make a dual comparison of outcomes between 52 patients seen in a traditional clinic. Finally, a pilot study was conducted in which patients fulfilling FTSCs were seen in a designated clinic.


RESULTS
An Oxford hip score (OHS) of 34 and above combined with severe loss of joint space, severe marginal osteophytes, or both was common to most patients on the waiting list (84%). FTSCs correctly predicted the outcome of the orthopaedic clinic in 38 patients out of a total of 52. During the pilot stage, positive FTSCs were shown to have a positive predictive value of 92% for joint replacement being carried out and a negative predictive value of 46%.


CONCLUSIONS
An OHS of 34 or above combined with complete loss of joint space and/or severe marginal osteophyte formation can be used to select patients who are very likely to need total hip replacement. These patients can be seen in a clinic that combines assessment of surgical indication with medical fitness for surgery.
Johnson
S A
SA
Department of Orthopaedics, St Helier Hospital, Carshalton, Surrey, UK.
Kalairajah
Y
Y
Moonot
P
P
Steele
N
N
Field
R E
RE
D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001175:Arthrography; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation; D006113:United Kingdom; D014850:Waiting Lists