An Audit of Ankle Arthritis Network: Preliminary Nottingham experience and Patient satisfaction

M Raglan, Y Myint, V Karuppiah, N Duncan, S Milner, H Kurup, H Salem, J May, C Loizou, J Carmichael

Aim: The ankle arthritis network is a polyaxial structure designed according to local resources and geography. The aim is to improve the outcome for patients, by facilitating referrals and communication, sharing expertise, supporting peers, minimizing clinical variation. BOFAS has signed off on a set of standards to encourage network development and best practice. The aim of this audit was to assess our network against this standard.

Methods: All referrals discussed at NUH regional MDT from August 2023 - 2024 were included. The prospectively collected data was assessed against the pilot BOAST documentation. All outcomes were recorded including network decision, patient surgery, and patient satisfaction.

Results: There were 7 hospitals involved in the regional MDT including NUH, which hosted the network meeting monthly over MS teams. 74 cases were discussed; 38 NUH, 8 Kings Mill Hospital, 7 United Lincolnshire Hospital, 5 Royal Chesterfield Hospital, 8, Peterborough City Hospital, 2 Nuffield Orthopaedic Centre Oxford and 6 Royal Derby Hospital. 26 were excluded as did not involve ankle joint sacrificing procedures, leaving 24 cases that involved discussion of complex ankle arthritis and 14 were failing Total Ankle replacements (fTARs); of these 10 cases were transferred to NUH and 9 had a revision TAR and 1 a complex primary TAR. The majority of standards were met apart from failure of standardised imaging across network and local follow up for transferred cases. All patients who had their care transferred within the network were satisfied, however those travelling from far preferred their follow up to be arranged locally.

Discussion: The Ankle Arthritis network as set by the pilot BOAST document is deliverable with appropriate admin support and clinician engagement. The biggest clinical impact was the transfer of fTARs for revision TAR. More work is needed regarding local imaging protocols, local patient follow up and implication’s on funding.