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UK SAFE-  Towards UK poSt Arthroplasty Follow-up rEcommendations

In the current economic climate there is increasing pressure to identify cost-saving measures across the NHS. Our recent work suggests that many centres are curtailing primary hip and knee arthroplasty follow-up services to deal with the growing pressure on their services. However, such disinvestment is without evidence-base and raises questions of the consequences to patients. This project will examine the requirements for arthroplasty follow-up and produce evidence and consensus-based recommendations as to how, when and on whom follow-up should be conducted. 


UK SAFE is a wider program of research funded by the NHS National Institute for Health Research (NIHR) Health Services & Delivery Research (HS&DR) project (ref: 14/70/146) led by the University of Leeds that covers four work packages:

WP1. To conduct systematic literature searching and synthesise literature to provide a robust evidence base for the cost-effectiveness modelling (WP3) and consensus guideline development (WP4)

WP2a. Use routine data from 5 national datasets (National Joint Registry, Hospital Episode Statistics, Patient Reported Outcome Measures, Clinical Practice Research Database and TPP SystmOne/ResearchOne) to understand when and which patients present for revision surgery

WP2b. Use prospective data collected on patients presenting for revision surgery to understand how they are currently identified for revision surgery

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 quality adjusted life years (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 the collective evidence from WP1-3 to inform a Delphi-consensus process to determine appropriate follow-up care pathways for total hip and knee arthroplasty

The principal investigator for the UK SAFE study is at University of Leeds. Oxford are co-applicants on the grant and leading work package 2a that will be using two separate data sources: 1) data from the NJR-HES-PROMS; 2) CPRD-HES linked data. This work package is being completed solely by the team at University of Oxford and University of Oxford is the sole data controller.

For more information on the wider programme of research, click here.


National linked datasets CPRD-HES, and NJR-HES-PROMS

  • Hospital Episode Statistics (HES) database holds information on all patients admitted to NHS hospitals in England,
  • Clinical Practice Research Datalink (CPRD) comprises the entire computerised medical records of a sample of patients attending general practitioners (GPs) in the UK.
  • Patient-Reported Outcome Measure (PROM) data has been collected on hip and knee replacements performed in public hospitals in England.
  • National Joint Registry (NJR) for England, Wales and Northern Ireland collects information on all hip and knee replacements performed each year in both public and private hospitals in England, Wales and, since 2012

These routine data from national datasets will be analysed to determine when revision happens to inform when follow-up should occur identify patients most likely to require revision to target who should be followed-up.

Two separate linked sets of data are to be obtained: 1) NJR-HES-PROMS linked datasets, and 2) CPRD-HES linked data. 

NJR-HES-PROMS data will not be linked with the CPRD-HES data or any other data.

Data Sources & Fair Processing

Large datasets from the NJR alongside data from NHS Digital will be used during this study. The personal identifiers of patients who had hip or knee replacement surgery and consented for their details to be stored in the NJR will be securely transferred to NHS Digital.  NHS Digital will link the data to information it collects and extract details of all hospital admissions (HES) for the study cohort and Patient Recorded Outcome Measures (PROMS).  NHS Digital will securely transfer the linked data to the University of Oxford as pseudonymised data (i.e. all identifiers will be removed and replaced with a unique patient ID).  The NJR will securely transfer pseudonymised information from its records to the University of Oxford using the same unique ID so that the data can be linked by the University of Oxford and processing in such a way that researchers will not be able to identify patients.    

Access patient information, and the NJR study website 

For more information about how the National Joint Registry and NHS Digital use patient information, including how it is collected and how patients can opt out, follow the links below:

NJR - Patient consent

NHS Digital - Data collection

NHS Digital - opt out

The lawful basis for processing: The lawful basis for processing under GDPR are Article 6(1)(e) (‘task in the public interest’) and 9(2)(j) (‘research purposes’).

Funding acknowledgement: The project UK SAFE project was funded by the NIHR HS&DR (project ref:  14/70/146)

Department of Health disclaimer: The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.