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Singh JA, Dowsey M, Choong PF. Patient Endorsement of the Outcome Measures in Rheumatology (OMERACT) Total Joint Replacement (TJR) clinical trial draft core domain set. BMC Musculoskelet Disord 2017; 18:111. [PMID: 28298194 PMCID: PMC5353795 DOI: 10.1186/s12891-017-1464-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A patient- and surgeon-Delphi-derived Outcome Measures in Rheumatology (OMERACT) draft core domain set for total joint arthroplasty (TJR) trials was recently developed. Our objective was to obtain further patient stakeholder endorsement of draft core domain set for TJR clinical trials. METHODS We surveyed two patient groups: (1) OMERACT patient partners; and (2) patients who had undergone hip or knee TJR. Patients received an introductory email with explanations about the core domain set and instructions to rate the core domains, i.e., important aspects, of OMERACT TJR clinical trial draft core domain set. Rating was on a nominal scale, where 1-3 indicated a domain of limited importance, 4-6 an important, but not critical domain, and 7-9 a critical domain. We used Mann-Whitney test (a non-parametric test) to compare the distribution of ratings between the two groups. RESULTS Thirty one survey participants from the OMERACT patient partner group and 118 knee/hip TJR patients responded with response rates of 66 and 80%, respectively. Majority of the survey respondents were female, 87 vs. 53%, and were 55 years or older, 57 vs. 94%. Median (interquartile range [IQR]) scores for six core domains by OMERACT and knee/hip TJR patient groups were, respectively: pain, 8 [8, 9] and 9 [8, 9]; function, 9 [8, 9] and 9 [8, 9]; patient satisfaction, 8 [8, 9] and 8 [7, 9]; revision surgery, 7 [7, 8] and 7 [5, 9]; adverse events, 8 [7, 9] and 8 [6, 9]; and death, 9 [6, 9] and 9 [4, 9]. No statistically significant differences in rating were noted for any of the six core domains between the two groups (p ≥ 0.31). Among the additional domains, ratings for patient participation did not differ by group (p = 0.98), but ratings for cost were significantly different (p = 0.005). Patients provided qualitative feedback regarding core domains, and did not propose any modifications to the draft core domain set. CONCLUSIONS Two separate patient stakeholder groups endorsed the OMERACT TJR draft core domain set for TJR trials.
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Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham, 510 20th Street S, Faculty Office Tower 805B, Birmingham, AL, 35294, USA. .,Birmingham Veterans Affairs Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
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Poitras S, Wood KS, Savard J, Dervin GF, Beaulé PE. Assessing functional recovery shortly after knee or hip arthroplasty: a comparison of the clinimetric properties of four tools. BMC Musculoskelet Disord 2016; 17:478. [PMID: 27852257 PMCID: PMC5112748 DOI: 10.1186/s12891-016-1338-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/10/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Following hip or knee arthroplasty, it is clinically warranted to get patients functional as quickly as possible. However, valid tools to assess function shortly after knee or hip arthroplasty are lacking. The objective was to compare the clinimetric properties of four instruments to assess function shortly after arthroplasty. METHODS One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively, 1 and 2 days postoperatively, and 2 and 6 weeks postoperatively with the Timed Up and Go (TUG), Iowa Level of Assistance Scale (ILAS), Postoperative Quality of Recovery Scale (PQRS), and Readiness for Hospital Discharge Scale (RHDS). Descriptive data, floor and ceiling effects, responsiveness, interpretation and construct validity were determined. RESULTS Only the ILAS and RHDS support subscale demonstrated floor or ceiling effects. A large deterioration from preoperative to postoperative, followed by large improvements after surgery were seen in the TUG and ILAS scores. The RHDS personal status subscale and the PQRS pain and function dimensions demonstrated large improvements after surgery. Changes in the RHDS global scale and personal status subscale, PQRS pain dimension and TUG were significantly related to patient perceived improvement. Minimal important changes were obtained for the RHDS global (1.1/10) and personal status subscale (2.3/10), and the TUG (43.4 s at 6 weeks). For construct validity, the PQRS function dimension and RHDS were moderately related to the TUG or ILAS. The correlation between TUG and ILAS was high from preoperative to postoperative day 2, but substantially decreased at 2 and 6 weeks. CONCLUSIONS The TUG and RHDS personal status subscale demonstrated the best clinimetric properties to assess function in the first 6 weeks after hip or knee arthroplasty.
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Affiliation(s)
- Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Kristi S Wood
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Geoffrey F Dervin
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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Prospective quality of life assessment after hip and knee arthroplasty: short- and mid-term follow-up results. Arthroplast Today 2016; 3:125-130. [PMID: 28695185 PMCID: PMC5485233 DOI: 10.1016/j.artd.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 01/04/2023] Open
Abstract
Background Hip and knee arthroplasty aims to restore the joint function and to improve health-related quality of life (HRQoL) in patients with articular damage. It is important to quantify the HRQoL improvement and when this is achieved. The Oxford knee score and the Oxford hip score were developed to evaluate patients after knee and hip arthroplasty. We sought to evaluate HRQoL changes in the short and mid term following either primary or revision hip and knee arthroplasty. Methods Prospective cohort study during a 20-month period (August 2013 to March 2015) in a tertiary referral hospital. Primary arthroplasties secondary to osteoarthritis and any-cause revisions were included (328, 160 knees, and 88 hips). They were divided into 4 groups: (1) primary knee replacement, (2) primary hip replacement, (3) revision knee replacement, and (4) revision hip replacement. Oxford knee and hip scores were obtained prior the surgery and compared with the short- and mid-term follow-up scores. Results Follow-up in the short term and mid term was: 75.6% and 67.4%, respectively. Improvement was found in both short-term and mid-term follow-up for each group and for the overall group in HRQoL as measured by the Oxford knee and hip scores (P < .001). The greatest improvement was seen in the short term with an increase of 21 points for primary knee arthroplasty; 24 points for primary hip arthroplasty; 22 points for revision knee arthroplasty; and 23 points for revision hip arthroplasty. Conclusions Improvement in HRQoL in patients following primary or revision hip or knee arthroplasty is crucial and can be achieved early after the surgery.
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Flores X, Vicente M, Haddad S, Amat C, Carrera L, Corona P. “Reverse” hip spacer for massive distal femur defects in peri-prosthetic knee infections. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Flores X, Vicente M, Haddad S, Amat C, Carrera L, Corona P. Espaciador de cadera «invertido» para defectos masivos de fémur distal en infecciones periprotésicas de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:346-354. [DOI: 10.1016/j.recot.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/07/2016] [Accepted: 06/25/2016] [Indexed: 12/19/2022] Open
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Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord 2016; 17:256. [PMID: 27286675 PMCID: PMC4901425 DOI: 10.1186/s12891-016-1106-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background Some aspects of validity are missing for the Harris Hip Score (HHS). Our objective was to examine the clinically meaningful change thresholds, responsiveness and the predictive ability of the HHS questionnaire. Methods We included a cohort of patients who underwent primary total hip arthroplasty (THA) and responded to the HHS preoperatively and at 2- or 5-year post-THA (change score) to examine the clinically meaningful change thresholds (Minimal clinically important improvement, MCII; and moderate improvement), responsiveness (effect size (ES) and standardized response mean (SRM)) based on pre- to post-operative change and the predictive ability of change score or absolute postoperative score at 2- and 5-years post-THA for future revision. Results Two thousand six hundred sixty-seven patients with a mean age of 64 years completed baseline HHS; 1036 completed both baseline and 2-year HHS and 669 both baseline and 5-year HHS. MCII and moderate improvement thresholds ranged 15.9–18 points and 39.6–40.1 points, respectively. ES was 3.12 and 3.02 at 2- and 5-years; respective SRM was 2.73 and 2.52. There were 3195 hips with HHS scores at 2-years and 2699 hips with HHS scores at 5-years (regardless of the completion of baseline HHS; absolute postoperative scores). Compared to patients with absolute HHS scores of 81–100 (score range, 0–100), patients with scores <55 at 2- and 5-years had higher hazards (95 % confidence interval) of subsequent revision, 4.34 (2.14, 7.95; p < 0.001) and 3.08 (1.45, 5.84; p = 0.002), respectively. Compared to HHS score improvement of >50 points from preoperative to 2-years post-THA, lack of improvement/worsening or 1–20 point improvement were associated with increased hazards of revision, 18.10 (1.41, 234.83; p = 0.02); and 6.21 (0.81, 60.73; p = 0.10), respectively. Conclusions HHS is a valid measure of THA outcomes and is responsive to change. Both absolute HHS postoperative scores and HHS score change postoperatively are predictive of revision risk post-primary THA. We defined MCID and moderate improvement thresholds for HHS in this study.
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Affiliation(s)
- Jasvinder A Singh
- Department of Medicine, Medicine Service, Birmingham VA Medical Center, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Departments of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA. .,Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA. .,Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA.
| | - Cathy Schleck
- Departments of Biostatistics, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Scott Harmsen
- Departments of Biostatistics, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - David Lewallen
- Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA
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Do articulating spacers or static spacers have more effect on the mental health status of patients undergoing two-stage revision total knee arthroplasty for periprosthetic joint infection? CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Singh JA, Schleck C, Harmsen WS, Lewallen DG. Validation of the Mayo Hip Score: construct validity, reliability and responsiveness to change. BMC Musculoskelet Disord 2016; 17:39. [PMID: 26785640 PMCID: PMC4719668 DOI: 10.1186/s12891-016-0868-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have provided the initial evidence for construct validity and test-retest reliability of the Mayo Hip Score. Instruments used for Total Hip Arthroplasty (THA) outcomes assessment should be valid, reliable and responsive to change. Our main objective was to examine the responsiveness to change, association with subsequent revision and the construct validity of the Mayo hip score. METHODS Discriminant ability was assessed by calculating effect size (ES), standardized response mean (SRM) and Guyatt's responsiveness index (GRI). Minimal clinically important difference (MCII) and moderate improvement thresholds were calculated. We assessed construct validity by examining association of scores with preoperative patient characteristics and correlation with Harris hip score, and assessed association of scores with the risk of subsequent revision. RESULTS Five thousand three hundred seven provided baseline data; of those with baseline data, 2,278 and 2,089 (39%) provided 2- and 5-year data, respectively. Large ES, SRM and GRI ranging 2.66-2.78, 2.42-2.61 and 1.67-1.88 were noted for Mayo hip scores with THA, respectively. The MCII and moderate improvement thresholds were 22.4-22.7 and 39.4-40.5 respectively. Hazard ratios of revision surgery were higher with lower final score or less improvement in Mayo hip score at 2-years and borderline significant/non-significant at 5-years, respectively: (1) score ≤55 with hazard ratios of 2.24 (95% CI, 1.45, 3.46; p = 0.0003) and 1.70 (95% CI, 1.00, 2.92; p = 0.05) of implant revision subsequently, compared to 72-80 points; (2) no improvement or worsening score with hazard ratios 3.94 (95% CI, 1.50, 10.30; p = 0.005) and 2.72 (95% CI, 0.85,8.70; p = 0.09), compared to improvement >50-points. Mayo hip score had significant positive correlation with younger age, male gender, lower BMI, lower ASA class and lower Deyo-Charlson index (p ≤ 0.003 for each) and with Harris hip scores (p < 0.001). CONCLUSIONS Mayo Hip Score is valid, sensitive to change and associated with future risk of revision surgery in patients with primary THA.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center and Department of Medicine, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Departments of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA. .,Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA. .,Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA.
| | - Cathy Schleck
- Departments of Biostatistics, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - W Scott Harmsen
- Departments of Biostatistics, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - David G Lewallen
- Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA
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Alternative outcome measures in young total hip arthroplasty patients: a prospective cohort study. Hip Int 2016; 25:152-9. [PMID: 25655738 DOI: 10.5301/hipint.5000200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 02/04/2023]
Abstract
In this prospective multicentre cohort study we studied subjects younger than 60 years of age scheduled for primary total hip arthroplasty (THA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sex-life. Questionnaires including Oxford Hip Score (OHS) and SF-36 were evaluated preoperatively and 3, 6 and 12 months postoperatively. OHS and SF-36 showed significant improvements (p<0.028, Wilcoxon Signed Rank test). THA did not affect the patients' socioeconomic status. Increased frequency of intercourse or better abilities in intercourse positions were experienced by 18 of 39 females due to reduced pain and increased range of motion. Patients sexually active before THA surgery remained active. These findings constitute important new information to young patients and surgeons during the decision making process.
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Wukich DK, Sambenedetto TL, Mota NM, Suder NC, Rosario BL. Correlation of SF-36 and SF-12 Component Scores in Patients With Diabetic Foot Disease. J Foot Ankle Surg 2016; 55:693-6. [PMID: 27052155 PMCID: PMC5664160 DOI: 10.1053/j.jfas.2015.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Indexed: 02/03/2023]
Abstract
The assessment of patient outcomes is becoming increasingly important in all areas of medicine, including foot and ankle surgery. The Medical Outcomes Study Short Form 36-item (SF-36) is widely used as a generic measure of quality of life; however, patients often find answering 36 questions cumbersome. Consequently, the Short Form 12 (SF-12) was developed. We hypothesized that the agreement between the SF-12 and SF-36 component scores would be substantial in patients with diabetic foot disease. We retrospectively reviewed the data from 300 patients with diabetes mellitus (DM) and foot and ankle pathology who completed the SF-36 questionnaire. Of the 300 patients, 155 (51.7%) had problems directly related to complications of DM and 145 (48.3%) had routine foot complaints that were unrelated to complications of DM. The 12 questions of the SF-12 were abstracted from the SF-36. The overall median score for the SF-36 physical component summary was 34.70 compared with the overall SF-12 physical component summary of 36.75 (p = .04). The intraclass correlation coefficient was 0.93688. The overall median score for the SF-36 mental component summary was 52.40 compared with the overall SF-12 mental component summary of 51.25 (p = .34). The intraclass correlation coefficient was 0.95449. Substantial agreement was observed when comparing the component scores of the SF-12 and the SF-36. From our study results of 300 patients with DM, it appears that the SF-36 and SF-12 are comparable outcome instruments for use with patients with diabetic foot disease.
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Affiliation(s)
- Dane K. Wukich
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA,University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Tresa L. Sambenedetto
- University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Natalie M. Mota
- University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Natalie C. Suder
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Bedda L. Rosario
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Keurentjes JC. CORR Insights(®): Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty. Clin Orthop Relat Res 2015; 473:3380-2. [PMID: 25791441 PMCID: PMC4586241 DOI: 10.1007/s11999-015-4252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/06/2015] [Indexed: 01/31/2023]
Affiliation(s)
- J Christiaan Keurentjes
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Kinov P, Volpin G, Sevi R, Tanchev PP, Antonov B, Hakim G. Surgical treatment of periprosthetic femoral fractures following hip arthroplasty: our institutional experience. Injury 2015; 46:1945-50. [PMID: 26115579 DOI: 10.1016/j.injury.2015.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/04/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Periprosthetic fractures are one of the most serious complications after hip replacement. The aim of this retrospective study was to evaluate the clinical outcome of surgical treatment of periprosthetic femoral fractures following total hip arthroplasty using treatment algorithm of the Vancouver classification. MATERIALS AND METHODS Fifty six periprosthetic femoral fractures operated on during the period December 2004-September 2013 were followed-up retrospectively. There were 40 women and 16 men with mean age at the time of surgery 64.7 years (41-88 years). The mean follow-up for the group was 5 years (range, 1-10 years). Periprosthetic fractures were classified according to the Vancouver classification. The clinical evaluation was performed with the Harris hip score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short Form 8 (SF-8). Bone healing, implant survival, pain, function and complications were recorded. Bone healing and implant stability were evaluated clinically and on plain radiographs. RESULTS Uneventful bone healing was achieved in 52 cases. In two fractures (one type B1, one type C) nonunion and plate failure occurred. Two cemented stems were revised for aseptic loosening 6.5 and 7 years after fracture fixation. Uncontrollable prosthesis infection and sepsis in a rheumatoid (immunocompromised) patient required disarticulation of the involved extremity. DISCUSSION AND CONCLUSIONS Periprosthetic femoral fractures are difficult to treat and require complex treatment approach according to risk assessment, fracture type, implant stability, bone stock and medical status of the patient. Using a treatment protocol of the Vancouver classification we obtained satisfactory outcome.
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Affiliation(s)
- Plamen Kinov
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria
| | - Gershon Volpin
- Department of Orthopaedic Surgery and Traumatology, EMMS Medical Center, Nazaret, Israel; The Galilee Medical Faculty Sfad, Bar Ilan University, Israel.
| | - Roger Sevi
- Department of Orthopaedic Surgery and Traumatology, Hillel Yafe Medical Center, Hadera, Israel
| | - Panayot P Tanchev
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria
| | - Boris Antonov
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, ul. Bialo more 8, 1527 Sofia, Bulgaria
| | - Geries Hakim
- Department of Orthopaedic Surgery and Traumatology, EMMS Medical Center, Nazaret, Israel; The Galilee Medical Faculty Sfad, Bar Ilan University, Israel
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Dowsey MM, Nikpour M, Dieppe P, Choong PFM. Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement. Clin Rheumatol 2014; 35:183-9. [DOI: 10.1007/s10067-014-2808-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 11/29/2022]
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Quality of life after total knee arthroplasty: systematic review. Rev Bras Ortop 2014; 49:520-7. [PMID: 26229855 PMCID: PMC4487445 DOI: 10.1016/j.rboe.2014.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/08/2013] [Indexed: 01/28/2023] Open
Abstract
Objective To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. Methods this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. Results 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. Conclusion The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.
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da Silva RR, Santos AAM, de Sampaio Carvalho Júnior J, Matos MA. Qualidade de vida após artroplastia total do joelho: revisão sistemática. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vogl M, Wilkesmann R, Lausmann C, Hunger M, Plötz W. The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study. Health Qual Life Outcomes 2014; 12:108. [PMID: 25273621 PMCID: PMC4159538 DOI: 10.1186/s12955-014-0108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to analyze the effect of preoperative patient characteristics on health outcomes 6 months after total hip replacement (THR), to support patient's decision making in daily practice with predicted health states and satisfaction thresholds. By giving incremental effects for different patient subgroups, we support comparative effectiveness research (CER) on osteoarthritis interventions. METHODS In 2012, 321 patients participated in health state evaluation before and 6 months after THR. Health-related quality of life (HRQoL) was measured with the EQ-5D questionnaire. Hip-specific pain, function, and mobility were measured with the WOMAC in a prospective observation of a cohort. The predictive capability of preoperative patient characteristics - classified according to socio-demographic factors, medical factors, and health state variables - for changes in health outcomes is tested by correlation analysis and multivariate linear regressions. Related satisfaction thresholds were calculated with the patient acceptable symptom state (PASS) concept. RESULTS The mean WOMAC and EQ-5D scores before operation were 52 and 60 respectively (0 worst, 100 best). At the 6-month follow-up, scores improved by 35 and 19 units. On average, patients reported satisfaction with the operation if postoperative (change) WOMAC scores were higher than 85 (32) and postoperative (change) EQ-5D scores were higher than 79 (14). CONCLUSIONS Changes in WOMAC and EQ-5D scores can mainly be explained by preoperative scores. The lower the preoperative WOMAC or EQ-5D scores, the higher the change in the scores. Very good or very poor preoperative scores lower the probability of patient satisfaction with THR. Shared decision making using a personalized risk assessment approach provides predicted health states and satisfaction thresholds.
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Affiliation(s)
- Matthias Vogl
- />Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, Neuherberg, 85758 Germany
- />Ludwig-Maximilians-Universität München, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Munich, Germany
| | - Rainer Wilkesmann
- />Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, Munich, 80639 Germany
| | - Christian Lausmann
- />Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, Munich, 80639 Germany
| | - Matthias Hunger
- />Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, Neuherberg, 85758 Germany
| | - Werner Plötz
- />Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, Munich, 80639 Germany
- />Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Naylor JM, Hayen A, Davidson E, Hackett D, Harris IA, Kamalasena G, Mittal R. Minimal detectable change for mobility and patient-reported tools in people with osteoarthritis awaiting arthroplasty. BMC Musculoskelet Disord 2014; 15:235. [PMID: 25015083 PMCID: PMC4105400 DOI: 10.1186/1471-2474-15-235] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/08/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Thoughtful use of assessment tools to monitor disease requires an understanding of clinimetric properties. These properties are often under-reported and, thus, potentially overlooked in the clinic. This study aimed to determine the minimal detectable change (MDC) and coefficient of variation per cent (CV%) for tools commonly used to assess the symptomatic and functional severity of knee and hip osteoarthritis. METHODS We performed a test-retest study on 136 people awaiting knee or hip arthroplasty at one of two hospitals. The MDC95 (the range over which the difference [change] for 95% of patients is expected to lie) and the coefficient of variation per cent (CV%) for the visual analogue scale (VAS) for joint pain, the six-minute walk test (6MWT), the timed up-and-go (TUG) test, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales were calculated. RESULTS Knee cohort (n = 75) - The MDC95 and CV% values were as follows: VAS 2.8 cm, 15%; 6MWT 79 m, 8%; TUG +/-36.7%, 13%; KOOS pain 20.2, 19%; KOOS symptoms 24.1, 22%; KOOS activities of daily living 20.8, 17%; KOOS quality of life 26.6, 44. Hip cohort (n = 61) - The MDC95 and CV% values were as follows: VAS 3.3 cm, 17%; 6MWT 81.5 m, 9%; TUG +/-44.6%, 16%; HOOS pain 21.6, 22%; HOOS symptoms 22.7, 19%; HOOS activities of daily living 17.7, 17%; HOOS quality of life 24.4, 43%. CONCLUSIONS Distinguishing real change from error is difficult in people with severe osteoarthritis. The 6MWT demonstrates the smallest measurement error amongst a range of tools commonly used to assess disease severity, thus, has the capacity to detect the smallest real change above measurement error in everyday clinical practice.
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Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J Arthroplasty 2014; 29:912-7. [PMID: 24269097 DOI: 10.1016/j.arth.2013.09.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/13/2013] [Accepted: 09/21/2013] [Indexed: 02/06/2023] Open
Abstract
In this prospective multicenter study we included subjects younger than 60 years of age and scheduled for primary total knee arthroplasty (TKA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sexual life. Questionnaires including Oxford Knee Score (OKS) and SF-36 were evaluated preoperatively and 3, 6, and 12 months postoperatively. OKS and SF-36 showed significant improvements. However, patient satisfaction and fulfillment of personal expectations did not reflect these scores. Overall, TKA did not affect the patients' socioeconomic status, and overall, patients did not experience impairment of sexual life, but decreased frequency and negative affection of sexual practice should be anticipated. Alternative outcome measurements of TKA surgery not focusing on implants and surgical techniques shed new light on important consequences of arthroplasty surgery.
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Singh JA, Lewallen DG. Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function. BMC Musculoskelet Disord 2014; 15:127. [PMID: 24725511 PMCID: PMC3990241 DOI: 10.1186/1471-2474-15-127] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA). METHODS We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993-2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented. RESULTS We studied 7,139 primary TKAs at 2- and 4,234 at 5-years; and, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of 'much better' knee functional status (relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of 'much better' knee functional status after revision TKA for every 5-point increase in score. CONCLUSIONS Depression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA.
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Corona PS, Barro V, Mendez M, Cáceres E, Flores X. Industrially prefabricated cement spacers: do vancomycin- and gentamicin-impregnated spacers offer any advantage? Clin Orthop Relat Res 2014; 472:923-32. [PMID: 24142302 PMCID: PMC3916603 DOI: 10.1007/s11999-013-3342-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/09/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known. QUESTIONS/PURPOSES We therefore sought to compare industrially prefabricated spacers containing either gentamicin or gentamicin and vancomycin with respect to (1) infection control, (2) complications, and (3) quality of life, pain, and patient satisfaction. METHODS We performed a review of 51 patients with chronic infections treated at one center using either gentamicin or vancomycin and gentamicin-prefabricated spacers. The former were used exclusively from January 2006 until May 2009, and the latter from June 2009 until July 2011, and there was no overlap. We collected data on demographics, immunologic status (McPherson classification), prosthetic joint infection location, type of prosthesis, microbiologic results, and time between stages. We evaluated the primary outcome of infection control or recurrence after at least 12 months followup. We also recorded complications. Each patient completed a quality-of-life survey, VAS, and a self-administered satisfaction scale. RESULTS The overall infection control rate was 83% after a mean followup of 35 months (range, 12.4-64.7 months). There were no differences between gentamicin and vancomycin and gentamicin spacers in terms of infection eradication (80 % versus 85 %, respectively; p = 0.73), nor in terms of complications, quality of life, pain, or satisfaction scores. CONCLUSIONS Prefabricated, antibiotic-loaded cement spacers has been proven effective for infection control in TKAs and THAs but with the numbers available, we did not find any differences between a gentamicin or vancomycin and gentamicin-prefabricated spacer, and therefore, we are unable to validate the superiority of the combination of vancomycin and gentamicin over gentamicin alone. Because of the higher costs involved with vancomycin and gentamicin spacers, and the potential risks of unselective use of vancomycin, further comparative studies are necessary to evaluate their role in the treatment of infected THAs or TKAs. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pablo S. Corona
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Reconstruction and Septic Surgery Division, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Department of Orthopaedic Surgery, Hospital de Traumatología y Rehabilitación Vall d′Hebron, Passeig Vall d′Hebron 119-129, 08035 Barcelona, Spain
| | - Victor Barro
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Marye Mendez
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Enric Cáceres
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Xavier Flores
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Reconstruction and Septic Surgery Division, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Desai N, Björnsson H, Samuelsson K, Karlsson J, Forssblad M. Outcomes after ACL reconstruction with focus on older patients: results from The Swedish National Anterior Cruciate Ligament Register. Knee Surg Sports Traumatol Arthrosc 2014; 22:379-86. [PMID: 24318509 DOI: 10.1007/s00167-013-2803-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate and analyse outcomes of patients over the age of 40 who had undergone anterior cruciate ligament (ACL) reconstruction and to compare them to their younger counterparts. We analysed patient-reported outcomes measured using the knee injury and osteoarthritis outcome score (KOOS) as well as aetiology of injury, concomitant intra-articular injuries and time from injury to surgery. METHODS Data were extracted from the Swedish National Knee Ligament Register during the period of 2005 through 2012. The following data were extracted and analysed: patient age, gender, activity at the time of injury, time between injury and reconstruction, concomitant intra-articular injuries, graft size used for reconstruction and KOOS measured pre-operatively as well as 1, 2 and 5 years post-operatively. The cohort was stratified into age groups of 0-19, 20-29, 30-39 and ≥ 40 years of age. RESULTS Pivoting sports were dominating as the cause of ACL injury in the younger age groups (up to 39 years). Alpine skiing and other non-specified activities were the most common causes in the older age group (≥ 40 years). Pre-operative KOOS was significantly lower in older age groups (p < 0.01). Post-operative KOOS regarding all subscales was significantly better in the older age group. The improvement in KOOS was significant with increasing age (p < 0.01). Older patients exhibited the greatest improvement in KOOS for all subscales at 1, 2 and 5 years post-operative follow-ups compared with pre-operative values (p < 0.01). Older patients had more cartilage injuries pre-operatively compared with younger patients. The same trend was observed in the older group for meniscus injury with and without cartilage injuries. The diameter of the graft used for ACL reconstruction was significantly larger in the older age groups and largest in the age group ≥ 40 years (p < 0.01). Older patients waited significantly longer for surgery after the ACL injury (p < 0.01). CONCLUSION In the older age groups, patients reported lower pre-operative KOOS compared with their younger counterparts. At follow-up, KOOS was similar in all age groups. From these results, we can therefore conclude that our hypothesis confirmed that optimal surgical results can in fact be achieved even in older patients.
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Affiliation(s)
- Neel Desai
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden,
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Keurentjes JC, Van Tol FR, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AWMM, Pöll RG, Nelissen RGHH. Patient acceptable symptom states after totalhip or knee replacement at mid-term follow-up: Thresholds of the Oxford hip and knee scores. Bone Joint Res 2014; 3:7-13. [PMID: 24421318 PMCID: PMC3928564 DOI: 10.1302/2046-3758.31.2000141] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives To define Patient Acceptable Symptom State (PASS) thresholds
for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term
follow-up. Methods In a prospective multicentre cohort study, OHS and OKS were collected
at a mean follow-up of three years (1.5 to 6.0), combined with a
numeric rating scale (NRS) for satisfaction and an external validation
question assessing the patient’s willingness to undergo surgery
again. A total of 550 patients underwent total hip replacement (THR)
and 367 underwent total knee replacement (TKR). Results Receiver operating characteristic (ROC) curves identified a PASS
threshold of 42 for the OHS after THR and 37 for the OKS after TKR.
THR patients with an OHS ≥ 42 and TKR patients with an OKS ≥ 37
had a higher NRS for satisfaction and a greater likelihood of being
willing to undergo surgery again. Conclusions PASS thresholds appear larger at mid-term follow-up than at six
months after surgery. With- out external validation, we would advise
against using these PASS thresholds as absolute thresholds in defining
whether or not a patient has attained an acceptable symptom state
after THR or TKR. Cite this article: Bone Joint Res 2014;3:7–13.
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Affiliation(s)
- J C Keurentjes
- Leiden University Medical Center, Departmentof Orthopaedic Surgery/Department of Medical Statistics, Albinusdreef2, Room J-09-127, PO Box9600, Postzone J-11-S, 2300RC Leiden, the Netherlands
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Keurentjes JC, Fiocco M, Nelissen RG. Willingness to undergo surgery again validated clinically important differences in health-related quality of life after total hip replacement or total knee replacement surgery. J Clin Epidemiol 2014; 67:114-20. [DOI: 10.1016/j.jclinepi.2013.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 04/14/2013] [Accepted: 04/18/2013] [Indexed: 12/27/2022]
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Total knee replacement; minimal clinically important differences and responders. Osteoarthritis Cartilage 2013; 21:2006-12. [PMID: 24095837 DOI: 10.1016/j.joca.2013.09.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis Index (WOMAC) in patients who have undergone total knee replacement (TKR). METHODS 1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0-100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cut-off values. RESULTS Global MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cut-off values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function. CONCLUSION Due to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.
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Singh JA, Lewallen DG. Patient-level improvements in pain and activities of daily living after total knee arthroplasty. Rheumatology (Oxford) 2013; 53:313-20. [PMID: 24162150 DOI: 10.1093/rheumatology/ket325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To study patient-level improvements in pain and limitations of key activities of daily living (ADLs) after primary or revision total knee arthroplasty (TKA). METHODS We analysed prospectively collected data from the Mayo Clinic Total Joint Registry for improvements in index knee pain severity and limitations in three key ADLs (walking, climbing stairs and rising from a chair) from pre-operative to 2 and 5 years post-TKA. RESULTS The primary TKA cohort consisted of 7229 responders pre-operatively, 7139 at 2 years and 4234 at 5 years post-operatively. The revision TKA cohort consisted of 1206 responders pre-operatively, 1533 at 2 years and 881 at 5 years post-operatively. In the primary TKA cohort, important pain reduction to mild or no knee pain at 2 years was reported by 92% with moderate pre-operative pain and 93% with severe pre-operative pain; respective proportions were 91% and 91% at 5 years follow-up. For revision TKA, respective proportions were 71% and 66% at 2 years and 68% and 74% at 5 years. Three per cent with no/mild pre-operative overall limitation and 19% with moderate/severe pre-operative overall limitation had moderate/severe overall activity limitation 2 years post-operatively; at 5 years the respective proportions were 4% and 22%. Respective proportions for revision TKA were up to 3% and 32% at 2 years and 4% and 34% at 5 years. CONCLUSION Our study provides comprehensive data for patient-level improvements in pain and key ADLs. These data can be used to inform patients pre-operatively of expected outcomes, based on pre-operative status, which may further help patients set realistic goals for improvements after TKA.
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Affiliation(s)
- Jasvinder A Singh
- University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA.
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Singh JA, Lewallen DG. Patients with osteoarthritis and avascular necrosis have better functional outcomes and those with avascular necrosis worse pain outcomes compared to rheumatoid arthritis after primary hip arthroplasty: a cohort study. BMC Med 2013; 11:210. [PMID: 24063410 PMCID: PMC3850929 DOI: 10.1186/1741-7015-11-210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/30/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study was conducted to assess whether patient-reported outcomes (PROs) differ by the underlying diagnosis (rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA), avascular necrosis of bone (AVN), other) in patients undergoing primary total hip arthroplasty (THA). METHODS We used prospectively collected data to assess the association of diagnosis with index hip function and pain. Moderate-severe activity limitation and moderate-severe pain were assessed at two- and five-year follow-up after primary THA using multivariable-adjusted logistic regression analyses. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS There were 5,707 primary THAs at two-years and 3,289 at five-years, 51% were women and the mean age was 65 years. The underlying diagnosis was RA in 3%, OA in 87%, AVN in 7% and other in 3%. In multivariable-adjusted analyses, compared to RA, diagnoses of OA and AVN were significantly associated with lower odds of moderate-severe activities of daily living limitations with an OR (95% CI) of 0.5 (0.3 to 0.8) (P = 0.01) and 0.4 (0.2 to 0.8) (P = 0.01), respectively, at two-years, but not at five-years, 0.7 (0.4 to 1.4) (P = 0.36) and 0.9 (0.4 to 1.8) (P = 0.78), respectively. At two-years, neither OA nor AVN were significantly associated with higher odds of moderate-severe pain (1.6 (0.6 to 4.5) (P = 0.40) and 2.8 (0.9 to 8.5) (P =0 0.06)), respectively. At five-years, AVN was associated with higher odds of moderate-severe pain with OR 4.1 (1.2 to 14.1) (P = 0.02), but not OA, 2.1 (0.7 to 6.5) (P = 0.22). CONCLUSIONS We found that patients with OA and AVN had better functional outcomes and those with AVN worse pain outcomes after primary THA, compared to patients with RA/inflammatory arthritis. Insights into mediators of these relationships are needed to better understand these associations.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and the Center for Surgical Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA.
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Blum MA, Singh JA, Lee GC, Richardson D, Chen W, Ibrahim SA. Patient race and surgical outcomes after total knee arthroplasty: an analysis of a large regional database. Arthritis Care Res (Hoboken) 2013; 65:414-20. [PMID: 22933341 DOI: 10.1002/acr.21834] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 08/13/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine racial differences in surgical complications, mortality, and revision rates after total knee arthroplasty. METHODS We studied patients undergoing primary total knee arthroplasty using 2001-2007 Pennsylvania Health Care Cost Containment Council data. We conducted bivariate analyses to assess the risk of complications such as myocardial infarction, venous thromboembolism, wound infections, and failure of prosthesis, as well as 30-day and 1-year overall mortality after elective total knee arthroplasty, between racial groups. We estimated Kaplan-Meier 1- and 5-year surgical revision rates, and fit multivariable Cox proportional hazards models to compare surgical revision by race, incorporating 5 years of followup. We adjusted for patient age, sex, length of hospital stay, surgical risk of death, type of health insurance, hospital surgical volume, and hospital teaching status. RESULTS In unadjusted analyses, there were no significant differences by racial group for either overall 30-day or in-hospital complication rates, or 30-day and 1-year mortality rates. Adjusted Cox models incorporating 5 years of followup showed an increased risk of revisions for African American patients (hazard ratio [HR] 1.39, 95% confidence interval [95% CI] 1.08-1.80), younger patients (HR 2.30, 95% CI 1.96-2.69), and lower risk for female patients (HR 0.81, 95% CI 0.71-0.92). CONCLUSION In this sample of patients who underwent knee arthroplasty, we found no significant racial differences in major complication rates or mortality. However, African American patients, younger patients, and male patients all had significantly higher rates of revision based on 5 years of followup.
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Affiliation(s)
- Marissa A Blum
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
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Ghalayini SRA, Helm AT, McLauchlan GJ. Minimum 6year results of an uncemented trabecular metal tibial component in total knee arthroplasty. Knee 2012; 19:872-4. [PMID: 22652203 DOI: 10.1016/j.knee.2012.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are theoretical advantages of using a trabecular metal tibial component in total knee replacement (TKR) for long-term survival. We have previously reported outcomes at 3 years. We now report the clinical and radiological outcome of an unselected series of 109 knees at a minimum of 6 years follow up. METHODS Patient function was assessed in a research clinic using Oxford Knee Score (OKS), Clinical and Functional Knee Society Score (KSS) and SF-12 physical score. Up to date weight bearing radiographs were obtained. RESULTS Seventy-six knees in 72 patients were available for assessment. OKS scores were maintained from the 3-year assessment with a mean of 36.1 (8.6). KSS and SF-12 scores declined slightly but only to a degree previously reported as normal age related change. The mean KSS at follow up was 87.2 (17.7). There was no radiographic evidence of loosening in any implant. There has been 1 revision for unexplained pain at 27 months. CONCLUSION The uncemented TMT in an unselected group is performing as well as any TKR implant at this stage. Future follow up is required to ensure this is maintained. The theoretical advantages may make this the prosthesis of choice in younger patients. LEVEL OF EVIDENCE IV. Case series.
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Blum MA, Ibrahim SA. Race/ethnicity and use of elective joint replacement in the management of end-stage knee/hip osteoarthritis: a review of the literature. Clin Geriatr Med 2012; 28:521-32. [PMID: 22840312 DOI: 10.1016/j.cger.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although much research has documented disparities exist for utilization of TJA, additional studies have shown that we have not narrowed the gap. Because multiple studies have shown that insurance and access to care are not necessarily underlying causes for these disparities, other studies have shown that there are real and significant differences between racial/ethnic groups in preferences for and expectations of joint arthroplasty. Additional research has established there are racial differences in certain postoperative processes and outcomes. Reasons have not been elucidated, but highlight the need for more research to understand these differences, their causes, and then to design interventions to minimize these inequalities.
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Affiliation(s)
- Marissa A Blum
- Division of Rheumatology, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Poitras S, Beaule PE, Dervin GF. Validity of a short-term quality of life questionnaire in patients undergoing joint replacement: the Quality of Recovery-40. J Arthroplasty 2012; 27:1604-1608.e1. [PMID: 22595180 DOI: 10.1016/j.arth.2012.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
One hundred thirty-two patients undergoing total hip or knee arthroplasty were evaluated before and after surgery with the Quality of Recovery-40 (QoR-40) and the Short Form 12 (SF-12) questionnaires seven times over a 4-month period, with the objective of comparing their psychometric properties. Physical dimensions of the QoR-40 and SF-12 were not related in the days after surgery but moderately related over the first month. Only the change in score for the physical independence dimension of the QoR-40 exceeded measurement error. Effect sizes were larger for the QoR-40 within the first month post-surgery and larger for the SF-12 past 1 month. Effect sizes were larger for the physical dimensions of both instruments compared to the psychological dimensions. Only the physical independence dimension of the QoR-40 appears useful to assess the quality of life in the first month following surgery.
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Király E, Gondos T. Cardiovascular diseases and the health-related quality of life after total hip replacement. J Clin Nurs 2012; 21:2843-50. [PMID: 22780856 DOI: 10.1111/j.1365-2702.2012.04101.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate to what degree total hip replacement, or co-morbidities or their progression, influence the health-related quality of life of patients after the operation. We have looked for an objective method to reflect the severity of cardiovascular diseases and to better characterise the health-related quality of life of patients with total hip replacement. BACKGROUND The main weakness of the different health-related quality of life methods that are applied to the analysis is the lack of information regarding the contributory role of co-morbidities, especially cardiovascular diseases. DESIGN Retrospective longitudinal study. METHODS This study involved 109 patients who had had total hip replacement. The patients' health status - objective and subjective functional performance at the time of operation and five years later - was evaluated using questionnaires (including EQ-5D and Western Ontario and McMaster Universities' Ostoearthritis Index scores) and the hospital database. An Objective Cardiovascular Classification grouping was developed to evaluate the deterioration of cardiovascular diseases. RESULTS The subjective assessment of the patients' health status at Year 5 revealed highly significant differences between healthy and sick patients in respect of EQ-5D and Objective Cardiovascular Classification but not in the case of the Western Ontario and McMaster Universities' Ostoearthritis Index scores. Evaluating postoperative subjective health awareness, a higher sensitivity and specificity and a significantly better individual-discriminating role was demonstrated in Objective Cardiovascular Classification vs. EQ-5D. CONCLUSION After successful total hip replacement postoperative health awareness is influenced mainly by existing and developing cardiovascular diseases. It seems to be the case that for patients with significant hypertension, ischaemic heart disease or chronic heart failure, even successful surgery will not improve the patients' overall feeling of health. RELEVANCE TO CLINICAL PRACTICE Nursing care of patients with total hip replacement, in respect of cardiovascular diseases, can contribute a better health-related quality of life.
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Affiliation(s)
- Edit Király
- Department of Surgery, Jávorszky Ödön Hospital, Vác, Hungary.
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Paulsen MG, Dowsey MM, Castle D, Choong PFM. Preoperative psychological distress and functional outcome after knee replacement. ANZ J Surg 2012; 81:681-7. [PMID: 22295307 DOI: 10.1111/j.1445-2197.2010.05634.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fifteen to thirty percent of patients report no or little functional improvement 12 months after total knee replacement (TKR). Self-reported psychological distress prior to knee replacement is common and there is some evidence that it may be an important determinant of poor functional outcome in the short to medium term. The aim of this study was to review systematically the literature on the relationship between preoperative psychological distress and post-operative functional outcome after TKR. METHODS A literature search through the University of Melbourne Library Catalogue, Web of Science, SCOPUS-V.4, Medline, CINAHL PLUS, PsycINFO, Pubmed and the Cochrane Library was performed with the following key words and terms: joint replacement, arthroplasty, mental health, pre-operative distress, preoperative distress, psychological distress and knee. Additional screening of the reference lists was performed. All eligible publications were quality assessed by two independent reviewers according to the Newcastle-Ottawa Scale. RESULTS The search found 10 cohort studies. The results of the studies were conflicting as six studies found a correlation between preoperative distress and functional outcome, whereas four did not. CONCLUSION The results from this review are conflicting. The use of different questionnaires to assess psychological distress and functional outcome makes it difficult to draw any conclusions. Future research should focus on using appropriate scales to measure exposure and outcome. We suggest using disease-specific questionnaires to assess preoperative psychological distress and a sensitive knee-specific outcome score to assess post-operative function.
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Affiliation(s)
- Mie G Paulsen
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
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83
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Keurentjes JC, Van Tol FR, Fiocco M, Schoones JW, Nelissen RG. Minimal clinically important differences in health-related quality of life after total hip or knee replacement: A systematic review. Bone Joint Res 2012; 1:71-7. [PMID: 23610674 PMCID: PMC3626243 DOI: 10.1302/2046-3758.15.2000065] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/20/2012] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We aimed first to summarise minimal clinically important differences (MCIDs) after total hip (THR) or knee replacement (TKR) in health-related quality of life (HRQoL), measured using the Short-Form 36 (SF-36). Secondly, we aimed to improve the precision of MCID estimates by means of meta-analysis. METHODS We conducted a systematic review of English and non-English articles using MEDLINE, the Cochrane Controlled Trials Register (1960-2011), EMBASE (1991-2011), Web of Science, Academic Search Premier and Science Direct. Bibliographies of included studies were searched in order to find additional studies. Search terms included MCID or minimal clinically important change, THR or TKR and Short-Form 36. We included longitudinal studies that estimated MCID of SF-36 after THR or TKR. RESULTS THREE STUDIES MET OUR INCLUSION CRITERIA, DESCRIBING A DISTINCT STUDY POPULATION: primary THR, primary TKR and revision THR. No synthesis of study results can be given. CONCLUSIONS Although we found MCIDs in HRQoL after THR or TKR have limited precision and are not validated using external criteria, these are still the best known estimates of MCIDs in HRQoL after THR and TKR to date. We therefore advise these MCIDs to be used as absolute thresholds, but with caution.
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Affiliation(s)
- J C Keurentjes
- Leiden University Medical Center, Department of Orthopaedic Surgery, Postbus 9600, 2300 RC, Leiden, The Netherlands
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84
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Escobar A, Gonzalez M, Quintana JM, Vrotsou K, Bilbao A, Herrera-Espiñeira C, Garcia-Perez L, Aizpuru F, Sarasqueta C. Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthritis Cartilage 2012; 20:87-92. [PMID: 22155074 DOI: 10.1016/j.joca.2011.11.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/08/2011] [Accepted: 11/14/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify new cut-off values beyond which patients can be considered as satisfied or as responders through patient acceptable symptom state (PASS) and OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) set of responder criteria in total joint replacement. METHODS Secondary analysis of a 1-year prospective multicenter study of 861 patients, 510 with total knee replacement (TKR) and 351 with total hip prosthesis (THR). Pain and function data were collected by the reverse scoring option of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). PASS values were identified with the 25th centile estimation using an anchoring question about satisfaction with actual symptoms. OMERACT-OARSI set of responder criteria was based on a combination of absolute and relative change of pain, function and global patient's assessment. Receiver operating characteristic (ROC) analysis was used as a complementary approach. RESULTS The values for PASS were about 80 and 69 for pain and function in THR, while these values were 80 and 68 when using OMERACT-OARSI criteria. Regarding TKR, PASS values were about 75 and 67 in pain and function with both criteria. ROC values were slightly lower in all cases. PASS and OMERACT-OARSI values varied moderately across tertiles of baseline severity. CONCLUSION With the provided data we can establish when a patient can be considered as satisfied/responder in joint replacement. The scores achieved at 1 year were very similar according to both criteria.
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Affiliation(s)
- A Escobar
- Unidad de Investigación, Hospital de Basurto - CIBER Epidemiología y Salud Pública (CIBERESP), Bilbao, Bizkaia, Spain.
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Validación de una escala reducida de capacidad funcional del cuestionario WOMAC. GACETA SANITARIA 2011; 25:513-8. [DOI: 10.1016/j.gaceta.2011.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/02/2011] [Accepted: 06/08/2011] [Indexed: 11/30/2022]
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KIRWAN JOHNR, BOONEN ANNELIES, HARRISON MARKJ, HEWLETT SARAHE, WELLS GEORGEA, SINGH JASVINDERA, FURST DANIELE, DWORKIN ROBERTH. OMERACT 10 Patient Perspective Virtual Campus: Valuing Health; Measuring Outcomes in Rheumatoid Arthritis Fatigue, RA Sleep, Arthroplasty, and Systemic Sclerosis; and Clinical Significance of Changes in Health. J Rheumatol 2011; 38:1728-34. [DOI: 10.3899/jrheum.110393] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This workshop reviewed progress in a number of areas related to patient perspective outcomes that were not specifically included within other areas of the program. A substantial review of the work of the valuing health outcomes group (the “QALY” working group) with participation and feedback from the plenary audience resulted in guidance to refocus on the use of patient preferences in the elaboration of more robust outcome measures for patient-reported outcomes and life impact measures. Progress and developments in the areas of fatigue and sleep in rheumatoid arthritis, outcome measures in hip and knee arthroplasty clinical trials, and scleroderma were outlined, and the challenge of truly understanding the nature of clinically important improvement was reviewed.
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Singh JA, Kundukulam J, Riddle DL, Strand V, Tugwell P. Early postoperative mortality following joint arthroplasty: a systematic review. J Rheumatol 2011; 38:1507-13. [PMID: 21724724 PMCID: PMC4262531 DOI: 10.3899/jrheum.110280] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties. METHODS Five databases were searched for English-language studies of mortality in hip or knee arthroplasties and the following data were extracted: patient characteristics (age, sex, ethnicity), arthroplasty characteristics (unilateral vs bilateral, hip vs knee), system factors (hospital volume and surgeon volume), year of study, etc. Mortality rates were compared across variable categories; proportions were compared using relative risk ratios and 95% confidence intervals. RESULTS Out of 650 titles and abstracts, 80 studies qualified for analysis. Of these, 35%, 34%, and 31% of studies provided 30-, 90-, and > 90-day mortality rates. Overall 30-day mortality rates across all types of arthroplasties were 0.3%; 90-day, 0.7%. For those reports with specific rates, 30-day mortality was significantly higher in men than women [1.8% vs 0.4%, respectively; relative risk (RR) 3.93, 95% CI 3.30-4.68] and in bilateral versus unilateral procedures (0.5% vs 0.3%; RR 1.6, 95% CI 1.49-1.72), but no differences were noted by the underlying diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (0.4% vs 0.3%; RR 0.77, 95% CI 0.48-1.24). 90-day mortality showed nonsignificant trends favoring women, OA as the underlying diagnosis, and unilateral procedures. CONCLUSION Several demographic and surgical factors were associated with higher 30-day mortality rates following knee and hip arthroplasties. More studies are needed to examine the effect of body mass index, comorbidities, and other modifiable factors, in order to identify interventions to lower mortality rates following arthroplasty procedures.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama, USA.
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Singh JA. Responsiveness differences in outcome instruments after revision hip arthroplasty: what are the implications? BMC Musculoskelet Disord 2011; 12:107. [PMID: 21605397 PMCID: PMC3118152 DOI: 10.1186/1471-2474-12-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022] Open
Abstract
Responsiveness to change is an important psychometric property of an outcome instrument. Assessment of health-related quality of life (HRQoL) is critical to outcome assessment after total joint replacement, a surgery aimed at improving pain, function and HRQoL of the patients undergoing these procedures. In a recent study, Shi et al. examined the responsiveness to change of various subscales of two instruments, physician-administered Harris Hip Score and patient self-administered Short Form-36 (SF-36), 6 months after revision total hip arthroplasty. The responsiveness statistics for both scales were reasonable, higher for Harris Hip Score than SF-36. This is the first study to examine responsiveness of these instruments in revision THA patients in a systematic fashion.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center and Department of Medicine, University of Alabama, Birmingham, USA.
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Singh JA, Gabriel S, Lewallen DG. Higher body mass index is not associated with worse pain outcomes after primary or revision total knee arthroplasty. J Arthroplasty 2011; 26:366-374.e1. [PMID: 20413245 PMCID: PMC2930933 DOI: 10.1016/j.arth.2010.02.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 02/19/2010] [Indexed: 02/01/2023] Open
Abstract
We assessed whether higher body mass index (BMI) is associated with higher risk of moderate-severe knee pain 2 and 5 years after primary or revision total knee arthroplasty (TKA).We adjusted for sex, age, comorbidity, operative diagnosis, and implant fixation in multivariable logistic regression. Body mass index (reference, b 25 kg/m2) was not associated with moderate severe knee pain at 2 years post primary TKA (odds ratio [95% confidence interval], 25-29.9, 1.02[0.75-1.39], P = .90; 30-34.9, 0.93 [0.65-1.34], P = .71; 35-39.9, 1.16 [0.77-1.74], P = .47; ≥ 40,1.09 [0.69-1.73], [all P values ≥ .47]). Similarly, BMI was not associated with moderate-severe pain at 5-year primary TKA and at 2-year and 5-year revision TKA follow-up. Lack of association of higher BMI with poor pain outcomes post-TKA implies that TKA should not be denied to obese patients for fear of suboptimal outcomes.
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Affiliation(s)
- Jasvinder A. Singh
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
,Department of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
,Rheumatology Section, Medicine Service, VA Medical Center, Birmingham, Alabama, USA
,Division of Rheumatology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Sherine Gabriel
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Alzahrani K, Gandhi R, Debeer J, Petruccelli D, Mahomed N. Prevalence of clinically significant improvement following total knee replacement. J Rheumatol 2011; 38:753-9. [PMID: 21239743 DOI: 10.3899/jrheum.100233] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although total knee replacement (TKR) has a high reported success rate, the pain relief and functional improvement after surgery vary. The purpose of our retrospective cohort study was to determine the prevalence of patients showing no clinically important improvement 1 year after TKR, and patient factors that may predict this outcome. METHODS We reviewed primary TKR registry data that were collected from 2 academic hospitals: the Toronto Western Hospital and the Hamilton Health Sciences Henderson Hospital in Ontario, Canada. Relevant covariates including demographic data, body mass index, and comorbidity were recorded. Knee joint pain and functional status were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS) to measure the change using the minimal clinically important difference (MCID). Logistic regression modeling was used to identify the predictors of interest. RESULTS Overall, 11.7% (373/3177) of patients reported no clinically important improvement 1 year after surgery. Logistic regression modeling showed that a greater patient age independently predicted no clinically important improvement on the WOMAC scale 1 year after surgery (p = 0.0003), while being male independently predicted no clinically important improvement on the OKS 1 year after surgery (p = 0.008). CONCLUSION Awareness of the prevalence of patients who may show no clinically important improvement and factors that predict this outcome will help patients and surgeons set realistic expectations of surgery.
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Affiliation(s)
- Khalid Alzahrani
- Division of Orthopedic Surgery, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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Singh JA, Lewallen D. Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord 2010; 11:90. [PMID: 20462458 PMCID: PMC2881019 DOI: 10.1186/1471-2474-11-90] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 05/13/2010] [Indexed: 12/30/2022] Open
Abstract
Background Study pain and use of pain medications and their predictors after primary Total Hip Arthroplasty (THA). Methods We examined whether gender, age (reference, < = 60 yrs), body mass index (BMI; reference, <25 kg/m2)), comorbidity measured by Deyo-Charlson index (5-point increase), anxiety and depression predict moderate-severe hip pain and use of pain medications 2- and 5-years after primary THA. Multivariable logistic regression adjusted for these predictors and distance from medical center, operative diagnosis, American Society of Anesthesiologists (ASA) score and implant type. Results Moderate-severe pain was reported by 8.1% at 2-years and 10.8% at 5-years. Significant predictors of moderate-severe pain at 2-year follow-up were [Odds ratio (95% confidence interval)]: BMI 35-39.9, 1.8 (1.2,2.8); BMI > = 40, 1.7 (1.0,2.9); depression, 2.1 (1.4,3.0). Moderate-severe pain at 5-years was more common in patients with higher BMI: 25-29.9, 1.5 (1.1,2.1); 30-34.9, 1.8 (1.2,2.6); 35-39.9, 1.9 (1.2,3.1); and > = 40, 3.1 (1.7,5.7). Significant predictors of NSAID use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 1.4 (1.1,1.7) and 1.4 (1.1,1.8); BMI 35-39.9 at 2-years, 1.9 (1.4, 2.6) and 30-34.9 at 2-years, 1.7 (1.2,2.4); and depression at 5-years, 1.8 (1.2,2.8). Significant predictors of opioid medication use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 2.0 (1.1,3.0) and 2.4 (1.4,4.0); BMI 30-34.9 at 2-years, 2.0 (1.0,3.9); and depression at 2-years, 2.0 (1.1,3.7). Conclusions Higher BMI and depression impacted moderate-severe pain; and female gender, higher BMI and depression predicted use of pain medications at 2- and 5-years post-primary THA.
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Affiliation(s)
- Jasvinder A Singh
- Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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