Early complications of total hip and knee replacement: a comparison of outcomes in a regional orthopaedic hospital and two independent treatment centres.
BACKGROUND
There is anecdotal evidence of poorer outcomes from prosthetic joint replacement performed in independent treatment centres but very few comparative studies.


METHODS
We compared the early re-operation, dislocation, re-admission, major wound infection and audit rates of 880 total hip (THA) and 874 total knee (TKA) arthroplasties carried out at a regional orthopaedic hospital (Avon Orthopaedic Centre; AOC) with 368 THAs and 365 TKAs from an NHS (WGH) and 67 THAs and 86 TKAs from a private hospital (CNH) independent treatment centre.


RESULTS
Early re-operation rates were 9% at CNH, 1.4% at WGH and 0.6% at AOC after THA and 8% at CNH, 1.9% at WGH and 1% at AOC after TKA. After THA, dislocation rates after THA were 6% at CNH and 1.8% at both WGH and AOC. Re-admission rates were 13% at CNH, 0.6% at WGH and 1.2% at AOC. Major wound problems were 20% at CNH, 3.8% at WGH and 0.4% at AOC after THA and 19% at CNH, 1.9% at WGH and AOC (1.1%) after TKA. After TKA, re-admission rates from CNH were 13%, 1% at WGH and 1.1% at AOC. AOC and WGH audited their outcomes. None were available from CNH.


CONCLUSIONS
Results and audit from independent treatment centres are variable and patients should be warned of this before undergoing treatment at them.
Bannister
Gordon
G
Avon Orthopaedic Centre, University of Bristol, Bristol, UK. gordon-bannister@tiscali.co.uk
Ahmed
Mansoor
M
Bannister
Miles
M
Bray
Rachel
R
Dillon
Paul
P
Eastaugh-Waring
Stephen
S
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D006269:Health Facilities, Proprietary / Q000592:standards*; D006302:Health Services Research; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data; D009985:Orthopedics / Q000458:organization & administration / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012017:Referral and Consultation; D012086:Reoperation / Q000706:statistics & numerical data; D013222:State Medicine / Q000458:organization & administration / Q000592:standards; D016896:Treatment Outcome