Supporting Regional Upper Limb Arthroplasty: The Impact of Establishing an Upper Limb Orthopaedic Network.

1 The Getting It Right First Time Report (GIRFT) has highlighted a worrying trend for primary and revision arthroplasty to be undertaken by centers and surgeons with low volume. 2 This is echoed in the National Joint Registry, where the median number of primary shoulder replacements completed per unit is 12 (interquartile range [IQR] 5–23) and 2 (IQR 1–4) for primary elbow replacements. 3 Subsequent British Elbow & Should Society guidelines propose that both primary and revision elbow replacements are performed at a centralized regional hub to ensure an adequate yearly caseload. 4 Our region provides care for ∼2 million people.

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However, the majority of these alterations were changes in either surgical technique or implant choice, both of which could be considered significant management changes and hence the patient's outcome.

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