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Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

Abstract：

BACKGROUND:In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS:A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS:A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS:This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices and correlate them with these nationally agreed guidelines.

journal_name

Ann R Coll Surg Engl

journal_title

Annals of the Royal College of Surgeons of England

authors

Malik MH,Gambhir AK,Bale L,Pradhan N,Porter ML

doi

10.1308/003588404322827509

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

113-8

issue

eissn

0035-8843

issn

1478-7083

journal_volume

pub_type

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Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.