This may be of interest to shareholders. It suggests poor...

This may be of interest to shareholders.  It suggests poor results are due to poor prosthesis.


Study identifies 122 orthopaedic surgeons having troubles


The cost of knee and hip procedures is forcing authorities to seek savings across the health system.A group of 122 orthopaedic surgeons had worse outcomes for hip and knee replacements than their peers, a landmark analysis has found, but substandard prostheses were often to blame.
The data from the National Joint Replacement Registry has also shown differences between public and private hospitals, raising the need for further scrutiny to determine the reasons for such variation and what can be done to prevent adverse outcomes.
With the ageing population and high rate of obesity, there is increased demand for knee and hip replacements. The cost of such procedures is forcing authorities to seek savings across the system — such as through the private sector’s Prostheses List — and ensure patients get the best results possible with their first operation.
The Australian Orthopaedic Association’s National Joint Replacement Registry collects data on outcomes and some of the factors contributing to poor results. This quality measure has helped deliver a low revision rate for hip and knee replacements, with a 31 per cent decline in revised hip procedures since 2003 and a 16 per cent drop in revised knee procedures since 2004.
For the first time, the registry has reported on variation rates among surgeons and hospitals and found a key factor is the choice of prostheses — despite the registry serving to red-flag the worst-performing devices and guide decisions made on behalf of patients.

In 2011, there were 18 prostheses identified as having higher than expected rates of revision, but last year there were only six.
The analysis also revealed 122 “outliers” (among 1427 surgeons recorded in the registry) whose revision rates were higher than normal. For hip replacement, 5.9 per cent of surgeons had a problem with dislocation and 6.2 per cent with an infection.
For knee replacement, 5.9 per cent rate had an infection issue and 5.8 per cent rate with loosening of the joint.
On closer analysis, it was found that almost all outliers, 87.7 per cent, had trouble in only one revision area, 11.5 per cent in two areas, 0.8 per cent in three and none in all four.
The registry was established with qualified privilege so the worst performing surgeons and hospitals cannot be identified.
The orthopaedic association’s president, Ian Incoll, said doctors and administrators could get their own results and have an Âopportunity to address them, perhaps by choosing prostheses shown to be associated with better results.
“There are many reasons why the rate of revision varies between surgeons and hospitals,” Dr Incoll said.
“The registry findings reveal that the critical determining factor for both surgeons and hospitals comes down to the type of prosthesis used in replacement surgery.”
Dr Incoll said he believed the next step for the registry would be to look at patient variability. This might include anaesthetics information to show how well a patient was before surgery, or Body Mass Index rates to identify patients who are obese.
The registry had been reporting BMI and looking at the relationship to surgery results.
There was not yet enough data to make predictions “but that will very likely come in the next couple of years”.