What’s in THA and TKA?

What’s in THA and TKA?

Historically, that’s what pathology has been tasked with determining: what useful pathological data exists in specimens from total hip arthroplasty (THA) and total knee arthroplasty (TKA). Current practice requires these orthopedic specimens to be sent to the pathology lab for examination, despite data suggesting that this examination rarely provides information above and beyond the clinical or radiological diagnosis and does not alter clinical management.

“Sometimes doing things ‘because this is the way we’ve always done them’ is not the right thing for patients, or for the health care system,” said Dr. Gabor Fischer, Diagnostic Services Manitoba (DSM) Pathology Medical Director. “The more we learn through research and clinical data and the more things change with technology and methods, it is important to evaluate the value of testing being done and the processes behind them – not just in pathology, but in all areas of the lab.”

Under the framework of Choosing Wisely Manitoba, and with the support of pathology champion, Dr. Fischer and Orthopedic Surgeon and clinical champion, Dr. Eric Bohm, DSM conducted a retrospective review of approximately 300 orthopedic surgery cases (representing one surgeon’s annual caseload) to correlate pathology findings with the original diagnostic imaging report.

“As evidence and experts had suggested, the results of our review supported the case that pathological testing of THA and TKA specimens did not add value to patient management or care,” Dr. Bohm. “Based on clinical and radiological data, clinicians can safely determine that in most cases, these orthopedic specimens do not require further pathological analysis.”

DSM has developed a Standard Operating Procedure which will be the basis for the Choosing Wisely Clinical Practice Change that will direct surgeons to mark these orthopedic tissues for immediate disposal. As a first stage of implementation, Concordia Hospital has stopped ordering pathology on these tissues as of June. Collaboration has already begun with surgeons to develop a process for disposal at the surgery site, which would further improve workflow and efficiency for these cases.

It is estimated that reducing unnecessary pathology testing on orthopedic specimens alone could result in a potential savings of $10,000 annually. Reinvestment of these funds will be shared between DSM and the Winnipeg Regional Health Authority Surgery Program, allowing for additional diagnostics and procedures.

This project was recognized by the American Society of Clinical Pathology (ASCP) as a finalist in the Best International Poster Award Competition at this year’s annual meeting in September.

DSM will add Manitoba data to the existing literature in support of this practice through a published paper that can help other jurisdictions implement similar processes. This project will also serve as a framework to reduce unnecessary pathological testing from other areas of surgery within Manitoba.

Congratulations to abstract authors Miao Vivian Lu, MD (Pathology Resident), Gabor Fischer MD, PHD (DSM Pathology Medical Director), Karen Cormier CT(ASCP) (DSM Pathology Coordinator), Jim Slater MLT(ART), MBA (DSM CEO) and Eric Bohm MD, MSc, FRCSC (Choosing Wisely Project Sponsor and Director Health Systems Performance, Centre for Healthcare Innovation) on their recognition by the ASCP.

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