YKC’s Dave Duffy looks at the implications of a report designed to ensure fewer knee procedures require revision.
Earlier this month, a study was published which looked at the guidance available to knee surgeons for classifying knee revisions (that is, work to correct or revise previous surgery). Revision knee classification is important, because only when everyone is classifying complex revision surgery the same way can you effectively share results between surgeons, learn from the results, and reduce the number of revisions required.
But of even greater importance was the report which led to the development of the classification system.
Getting it Right First Time (GIRFT) is, as the programme’s own website states, “a national programme designed to improve the quality of care within the NHS by reducing unwarranted variations.”
It has been led by Prof. Tim Briggs who is an advocate of placing more work with specialist surgeons in specialist centres. That may sound obvious – clearly a knee surgeon who performs dozens of the same type of operation every year is bound to be more experienced – and more familiar with the out of the ordinary – than someone who performs one or two. You might think the health service has been operating this way for years.
And yet, a year or so ago when we looked at the National Joint Registry (which records the procedures carried out by joint surgeons across the UK) it was interesting – and a little unnerving – to find that the single most common number of partial knee replacements tackled annually by surgeons was one.
When Prof Briggs visited NHS trust (Mid Yorks) and asked “who’s doing partial knees?” about ten hands went up. He rightly explained why that was too many, which is when my Yorkshire Knee Clinic colleague Jim Newman became the one of the prime partial knee replacement surgeons for that particular hospital trust (going from performing 15 or so a year to doing 70-100 annually). Naturally, you become far more specialised far more quickly doing such a large number of operations.
Knee revision complexity
The value of centralising complex work becomes even clearer in the case of knee revisions. Revisions are more unpredictable. There’s more patient-specific ‘kit’ required (implants etc). Surgery often takes longer and the complexity often requires two surgeons to be present.
Prof. Briggs reported that these should be done in specialised units (i.e. major centres such as Mid Yorks), by surgeons who deal with complex knee conditions all the time.
So when you’re researching knee surgeons (private or NHS), focus on the surgeon’s experience in your particular procedure. That way, there’s a far greater chance they’ll get it right first time.
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