Development of assessment in hip arthroplasty review

This thesis describes the development of aspects of assessment in hip arthroplasty review. Although many hip replacements provide pain relief and improved function, periodic review is advised to assess the state of the joint in order to identify a failing hip arthroplasty. A literature search was conducted to establish methods of assessing failing hip arthroplasty and the findings are summarised. There was a lack of standardisation but an emphasis on the need for review because failing hip arthroplasty is frequently asymptomatic. The review process may be conducted by medical or non-medical members of the orthopaedic team. A lack of formal educational programmes in arthroplasty review has led to innovative ways of non-medical health professionals achieving the required competency. One of these methods is described to show the development of a skill in radiographic image interpretation for hip replacements. Image interpretation is an important component of hip arthroplasty review and includes the measurement of osteolytic lesions, a phenomenon generally considered to be caused by the wear particles produced from the articulating surfaces of the artificial joint. A simple, radiographic tool was developed to measure these irregularly shaped lesions and its testing is described. The tool was found to be valid and reliable when used interchangeably between any professional who is part of an orthopaedic team conducting hip arthroplasty review. Finally, a clinical study of hip arthroplasty was conducted to explore the relationship between changes in a patient reported outcome measure (PROM) and radiographic changes over the same period of time. AII study participants had a hip replacement approximately seven years earlier and were at a stage (mid-term) when signs of deterioration of the hip joint often appear. The results showed that radiographic changes were not predicted by changes in the PROM over the same period. This thesis illustrates a training model for non-medical health professionals to acquire the skill of radiographic image interpretation and employs basic research to develop a simple and reliable radiographic tool for use in hip arthroplasty review. It shows that, for patients reviewed at mid-term, it is important to include an x-ray because a joint-specific PROM is not able to predict the radiographic changes around a hip replacement. This information adds to the scientific evidence for assessment in hip arthroplasty review. It is of potential benefit to patients through the improvement of current surveillance methods and future planning of hip arthroplasty review.EThOS - Electronic Theses Online ServiceGBUnited Kingdo