The John Charnley Award - Practice surveillance: A practical method to assess outcome and to perform clinical research

The senior author systematically began collecting preoperative and postoper ative data on all the total hip arthroplasties he performed starting in Jul y 1970. The data collected represent a 26-year experience using practice su rveillance (preoperative and regular interval postoperative collection and analysis of outcomes) as a method to document the outcome of the total hip arthroplasty procedure and as a method to evaluate the need for changes in the procedure. As the senior author made few selected changes in the operat ive procedure during the followup period, the primary author has been able to evaluate the change in outcome based on these changes. The six studies r eported in the current study show the durability of the long-term results o f cemented total hip arthroplasty, the improvement in radiographic reproduc ibility obtained on the femoral side of the construct with improved cementi ng techniques, the deleterious effects of using cable to reattach the great er trochanter, the deleterious effects of changing femoral component design that included a change in surface finish, the improvement in acetabular fi xation using cementless fixation, and the optimization of bearing surface w ear using smaller diameter femoral heads. All of these findings have been i ncorporated into the primary surgeon's practice based on this practice surv eillance. As shown, practice surveillance also has provided a tool for perf orming clinical research. Although practice surveillance of controlled coho rts never will supplant prospective randomized clinical trials in evidence based medicine, it should help each surgeon with his or her own practice an d can be used as an important research tool to study the optimization of ou tcomes of a surgical procedure.