The role of the advanced clinical practitioner in arthroplasty care
Demand for joint arthroplasty surgery in the UK has increased significantly over the past 10 years. Advanced clinical practitioner (ACP) roles in arthroplasty care, typically fulfilled by expert nurses or physiotherapists, have been developed to alleviate service pressures and facilitate care for the growing number of patients undergoing arthroplasty surgery. There are numerous different models of ACP-led services both in the UK and internationally, driven by local service and population needs. ACPs in arthroplasty care will be involved throughout the patient journey, including pre-operative assessment, peri-operative care and long-term surveillance. ACPs in arthroplasty care will develop expertise across all four pillars of advanced clinical practice and have the potential to influence and contribute to the development of guidance and policy for the future of arthroplasty care delivery, ensuring best quality, evidence-based practice is achieved.
Changing demographics and an ageing population have influenced an increased demand for arthroplasty surgery globally in the past three decades. The National Joint Registry for England, Wales and Northern Ireland (National Joint Registry (NJR), 2022) has recorded an increase of total hip replacement procedures from 42 484 to 98 649 and knee replacement procedures from 41 584 to 106 572 between 2004 and 2019; shoulder replacement procedures have also increased from 2545 in 2012 (when they were first added to the registry) to 7660 in 2019. These trends are also reflected in Scotland, and the Scottish Arthroplasty Project (2020) report numbers of hip, knee and shoulder replacements increasing between 2001 and 2019 from 4219 to 7929, 3343 to 7720 and 234 to 543, respectively.
Similar patterns have also been recorded internationally (Swedish Arthroplasty Register, 2021; Australian Orthopaedic Association National Joint Replacement Registry, 2022; Canadian Institute for Health Information, 2022; New Zealand Joint Registry, 2023). These increasing numbers, coupled with pressures on services from changing government targets and relative funding and staff cuts, have meant that new models for providing care for these patient groups are essential to improve access to services and reduce waiting times. In 2020, due to the effects of the COVID-19 pandemic on elective surgical procedures, there was a sudden decline in arthroplasty procedures across all groups (NJR, 2022) this has since resulted in soaring waiting times for routine procedures and further emphasised the requirement for efficient models of care delivery.
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