Evaluation of the Multi-Attribute Prioritisation Tool for Total Joint Replacement.

RATIONALE AIMS AND OBJECTIVES: The demand for arthroplasty is increasing and will continue to rise with an ageing population. Obesity and lengthy waiting time for Total Joint Replacement (TJR) have been associated with poorer outcomes postoperatively. This study aimed to evaluate the Multi-Attribute Prioritisation Tool (MAPT) for TJR patients. The primary objective was to explore if patients prioritised by the MAPT had an improvement in score post-operative. Further to identify any relationship between MAPT score and length of time on the waiting list or obesity. METHOD: This retrospective cohort study included 308 patients undergoing total hip (n = 114) or total knee (n = 194) arthroplasty. We examined preoperative and postoperative MAPT scores of patients who had total hip or total knee arthroplasty. After assessing the difference between postoperative and preoperative MAPT scores, patients scores were compared to BMI and waiting time classes. BMI was allocated to less than 30, 30-35, 35-40 and greater than 40. Duration of time on the waiting list was allocated to less than 6 months and greater than 6 months. RESULTS: THA and TKA patients MAPT scores improved from a preoperative score of 71.39-5.26 postoperative and 54.11 to 7.13 respectively. Patients whose MAPT scores placed them in the high priority category had a significant relationship with length of time on the waiting list (p < 0.01). There were no significant differences between length of time on the waiting list and improvement scores for low priority and middle priority patients. BMI had minimal effect on patients improvement score postoperative. CONCLUSION: TJR patients prioritised by the MAPT questionnaire do experience pain relief as portrayed by a reduction in postoperative MAPT score. A longer length of time on the waiting list seems to effect the improvement a high priority patient can have postoperative.

Implementation of a quality care management system for patients with arthritis of the hip and knee.

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.