ABSTRACT
BACKGROUND: The Southern Adelaide Local Health Network is serviced by one orthopaedic surgeon specialising in foot and ankle surgery. In 2011, the waiting list to see the surgeon was expanding and the need for assistance was growing. The Department of Podiatry agreed to provide a podiatrist to assist in the management of the outpatient waiting list. Although patient outcome is an important outcome measure, we were interested in evaluating the service with respect to how satisfied patients were with seeing a podiatrist. Therefore, the primary aim of the study was to evaluate patient satisfaction with podiatry-led clinics for the orthopaedic outpatient waiting list. Secondary outcomes included discharge rate and efficiency of care. METHODS: We prospectively recruited a consecutive sample discharged from the Department of Podiatry between 1 May and 1 November 2013 to complete the Client Satisfaction Survey (CSQ-8). This survey was used to evaluate the satisfaction of patients following discharge from the Department of Podiatry. RESULTS: There were 49 patients (16 men, 33 women) enrolled in the survey during the 6-month period. Of the 49 patients discharged, 21 (43%) were discharged from the outpatient waiting list. Twenty-eight patients (57%) were referred on to the Department of Orthopaedic Surgery for opinion and management. The mean (± s.d.) number of appointments for each patient was 1.3±0.6. Overall, patients were very satisfied with the assessment and/or treatment they received. CONCLUSION: A podiatrist, working at an extended scope of practice and in collaboration with an orthopaedic surgeon, can successfully and efficiently assess and treat patients on an orthopaedic outpatient waiting list. Patients generally reported a high level of satisfaction with the process and would return to the clinic again if necessary. Hospital networks wanting to efficiently reduce waiting lists may endorse task substitution for appropriately skilled podiatrists.
Subject(s)
Orthopedic Procedures , Orthopedics/organization & administration , Patient Satisfaction , Podiatry , Triage , Adult , Aged , Efficiency, Organizational , Female , Humans , Male , Middle Aged , Prospective Studies , Referral and Consultation , Surveys and Questionnaires , Waiting ListsABSTRACT
The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.
Subject(s)
Health Plan Implementation/organization & administration , Osteoarthritis, Hip , Osteoarthritis, Knee , Patient Care Management/organization & administration , Quality Assurance, Health Care/organization & administration , Arthroplasty, Replacement, Hip/standards , Arthroplasty, Replacement, Knee/standards , Efficiency, Organizational , Health Plan Implementation/methods , Humans , Length of Stay/trends , Models, Organizational , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/rehabilitation , Osteoarthritis, Hip/surgery , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/rehabilitation , Osteoarthritis, Knee/surgery , Patient Care Management/methods , Quality Assurance, Health Care/methods , Quality Indicators, Health Care , Referral and Consultation/standards , Severity of Illness Index , South Australia , Triage , Waiting ListsABSTRACT
A prospective cohort of 30 patients undergoing primary total hip arthroplasty for treatment of osteoarthritis was enrolled in a study to characterize the migration behavior of a clinically successful cementless stem. At 6 years, the mean subsidence of the stem was 0.63 mm (range, -0.33 to 3.68 mm); the mean rotation into retroversion was 1.41° (range, -1.33° to 7.48°). No stems had additional subsidence of more than 0.25 mm between 6 months and 6 years. The resultant mean subsidence between 2 and 6 years was 0.03 mm, which is below the limit measurable by radiostereometric analysis. The data demonstrate that subsidence of this cementless stem occurs within the first 6 months, after which there is persistent stabilization.
Subject(s)
Durapatite , Femur/diagnostic imaging , Femur/surgery , Hip Prosthesis , Prosthesis Failure/trends , Radiostereometric Analysis/methods , Aged , Aged, 80 and over , Cohort Studies , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Joint Instability , Male , Middle Aged , Osteoarthritis, Hip/surgery , Prospective Studies , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: The 'obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40). METHODS: A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. RESULTS: Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10-30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3-9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. CONCLUSIONS: Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery.
