A study published in the Journal of Bone and Joint Surgery examines the internet-enhanced multidisciplinary team working approach from August 2012 to April 2014. There were 215 patients who participated with 266 metal-on-metal hip arthroplasties. Around 236 of the patients had primary arthroplasties — 132 hip resurfacing and 104 total hip replacements. Those were the patients included in the study.
The team’s goal was to reduce the uncertainty in surgeon-level decision-making. The researchers found:
1. The average Oxford Hip Score was 35.
2. The average cobalt level in whole blood was 3.54 ppb and the average chromium level in whole blood was 3.17 ppb.
3. The MRI showed abductor muscle atrophy in 92 patients — 39 percent — of the hips; around 34 percent of the patients reported pseudotumor.
4. The internet-enhanced multidisciplinary team recommended these treatments for the patients:
• Monitoring: 146 patients — 61.9 percent
• Further investigation: 30 patients — 12.7 percent
• Surgery: 60 patients — 25.4 percent
5. In 91.7 percent of these patients the actual outcome was concordant with the recommendation.
“Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance and up-to-date evidence to improve decision making among surgeons,” concluded the study authors. “The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.”
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