1. Towards UK poSt Arthroplasty Follow-up rEcommendations: UK SAFE
Sarah Kingsbury PhD BSc
Osteoarthritis Strategic Lead, University of Leeds
and NIHR Leeds Musculoskeletal Biomedical Research Unit

2. Where did it all start? TJR a massive problem (>150K in 2013)
A clinical observation: wide variation in follow-up of total joint replacement patients across the country

3. Where next? Pulled together a team with Orthopaedic surgeon
MSK researchers with interest in routine data
Arthroplasty (AHP) practitioner
AHC team including methodological and big data expertise

4. Where did it go wrong?
We submitted an application for an NIHR PG in Shortlisted for a second stage application, however whilst the relevance and importance of the proposal was recognised, not funded:
Lack of epidemiological expertise on the research team
Feasibility of data linkage
Participant burden related to qualitative work-packages

5. New grant objectives (1)
To identify who needs follow up and when this should occur for primary THR and TKR (including uni-compartmental knee) by making use of routine data
To understand the patient journey (in primary and secondary care) to revision surgery by recruiting patients admitted for elective and emergency revision surgery

6. New grant objectives (2)
To establish how and when patients are identified for revision by using prospective and retrospective data
To identify the most appropriate and cost-effective follow-up pathway to minimise potential harm to patients by undertaking cost-effectiveness modelling
To provide evidence- and consensus-based recommendations on how follow-up of primary hip and knee arthroplasty should be conducted

7. Work Package 1
SLR to provide a robust evidence base for cost-effectiveness modelling and consensus guideline development by:
Identifying literature evaluating follow-up care pathways after primary arthroplasty
Providing studies of epidemiology, clinical effectiveness, safety, utilities, preferences and resource costs to populate the model parameters alongside WP2 data
Synthesizing studies of effectiveness, safety, acceptability, disinvestment and missed opportunities in follow-up care

8. Work Package 2
Use routine data from 5 national datasets to understand when and which patients present for revision surgery
1) NJR-HESPROMS data - to model time to revision to determine when follow-up should occur.
2) NJR-PROMS-HES linked data, together with CPRD-HES and R1-HES - to understand primary care involvement and examine which patients are most likely to require intervention
Use prospective data collected on 675 patients presenting for revision surgery to understand how they are currently identified for revision surgery

9. Work Packages 3 & 4 WP3: Determine how follow-up should occur by
Estimating primary and secondary care costs of current practice and different models of follow-up care
Using Markov modelling to simulate long-term costs and QALYs associated with each selected care model against current practice
Estimating the proportion of ‘timely’ revision (i.e. before the joint fails) associated with each care model
WP4
Use WP1-3 to inform a Delphi-consensus process to determine appropriate follow-up care pathways for total hip and knee arthroplasty

10. With thanks to the AHC: We started December 1
This is somewhat simplistic cos drugs likely have pleitropic effects