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

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

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

Where did it go wrong? We submitted an application for an NIHR PG in 2013. 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

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

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

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

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

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

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