AOA Position statement questions Flashcards
Tell us about the concept of short stay arthroplasty
Short stay arthroplasty refers to a care model for arthroplasty patients with a shorter length of stay of <48h rather than the typical 3-4 days or longer.
It is an important model to consider as it has benefits for patients in encouraging early mobility and reducing complications such as DVTs and hospital acquired infections. It also has associated cost benefits in reducing the length of stay.
The AOA has a position statement on this type of approach.
It is considered typically for younger patients with good support networks and less comorbidities.
When considering a short stay model is it important that a multi-disciplinary team approach is considered and that the surgical team, anaesthesist, nurses and allied health staff are all involved in ensuring a safe transition out of hospital for the patient.
Ultimately, applying this model cannot come at the expense of patient safety and patients much be ready to return home and not rushed to a discharge that is not safe.
In summary I think it is a very important approach to consider for arthroplasty patients and when applied in the right setting to the right patients it can have widespread benefits and provide good outcomes for patients.
What is your view on robotic-assisted joint replacement
Robotic assisted joint arthroplasty is a relatively new development in orthopaedics and there his growing interest in its use for hip and knee replacement.
It is another example of technological advances looking to improvement techniques and outcomes for patients in orthopaedic surgery.
The Australian Arthroplasty Society has a position statement on robotic assisted joint arthroplasty and acknowledge that it will take time to obtain the necessary data to clearly outline its role and determine if it provides superior outcomes. There are some encouraging early results from the joint registry particularly in relation to partial knee replacement revision rates. It acknowledges also that there is currently insufficient evidence to show that robotic assisted surgery delivery better outcomes for hip or knee replacements.
I think robotic assisted joint replacement is an exciting new technology that certainly has the potential to improve techniques and patient outcomes, but as with all advances in medicine it is important that the scientific literature guides is use and more information is gathered.
What do you think about surgeons claiming an advantage for their approach to hip arthroplasty
The use of different surgical approaches for total hip arthroplasty and their potential advantages and disadvantages is a topic frequently discussed in orthopaedics, and the Arthroplasty society has a position statement on the subject.
There are a number of surgical approaches that can be used for THA, all are capable of providing a long-lasting successful result. Some have advantages and disadvantages over others and these can be patient specific.
There is no published level 1 evidence that demonstrates one approach be superior to another.
Ultimately I think that surgeons should have an open discussion with their patients, and inform them of the approach that they feel is best for them and that works best in their hands, however should not claim that their approach is the superior approach.
Do you think a fly in fly out orthopaedic service is appropriate
The ideal orthopaedic model of care involves the orthopaedic surgeon residing in the town where they are providing the service, and the AOA has a position statement on this subject.
However, in rural and remote areas where there is not a local orthopaedic surgeon, it may be appropriate for a FIFO service. However, some measures must be considered to ensure optimal patient safety and outcomes.
Firstly, the surgeon should be available for the immediate post-operative period where possible. There must be local medical support available for follow-up and to deal with complications that arise.
Secondly, an appropriate patient population and appropriate procedures should be chosen depending on the level of support available.
Ultimately FIFO can be an appropriate model to provide orthopaedic care to an area where this would not otherwise be possible. However, these considerations must carefully be taken into account in order to avoid complications and maximise patient outcomes.
Do you think a fly in fly out orthopaedic service is appropriate
The ideal orthopaedic model of care involves the orthopaedic surgeon residing in the town where they are providing the service, and the AOA has a position statement on this subject.
However, in rural and remote areas where there is not a local orthopaedic surgeon, it may be appropriate for a FIFO service. However, some measures must be considered to ensure optimal patient safety and outcomes.
Firstly, the surgeon should be available for the immediate post-operative period where possible. There must be local medical support available for follow-up and to deal with complications that arise.
Secondly, an appropriate patient population and appropriate procedures should be chosen depending on the level of support available.
Ultimately FIFO can be an appropriate model to provide orthopaedic care to an area where this would not otherwise be possible. However, these considerations must carefully be taken into account in order to avoid complications and maximise patient outcomes.
Is it appropriate for a patient to under simultaneous total knee replacements
Undergoing a total knee replacement is a significant procedure for any patient to undergo and it comes with significant risks that the patient must be aware of. Undergoing two TKRs simultaneously adds to this risk so a decision to do so must be taken carefully and the AOA has a position statement on this.
Firstly the medical care of the patient must always prevail over the want to expedite their orthopaedic procedures.
Decision to do should be done under a shared decision making approach with input from the anaesthetic team following an appropriately thorough pre-operative workup.
The patient’s comorbidities should be taken into account and it should be acknowledged that the risk of complications is higher and the length of stay in hospital is likely to be higher.
Simultaneous TKRs can have a specific advantage for the rehabilitation of patients with fixed flexion deformities and this can be taken into consideration when making the decision.
So in summary it can be appropriate to do simultaneous TKRs however the risk of complications should be acknowledged and there should be a multi-disciplinary team approach to making the decision.
