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Drużbicki M, Kitrys Ł, Jabłoński J, Filip D, Perenc L, Guzik A. Return to Work after Primary Total Knee Arthroplasty: The First Polish Pilot Retrospective Study. J Clin Med 2024; 13:1902. [PMID: 38610666 PMCID: PMC11012819 DOI: 10.3390/jcm13071902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/02/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Total knee arthroplasty (TKA) performed on working-age patients significantly affects the participation of such patients in social life. A retrospective study was conducted to determine the return to work (RTW) rate after TKA. The goal of this study was to provide reference data for the Polish population and identify the factors impacting patients' decisions to return to or resign from work, relative to their functional performance. (2) Methods: This retrospective study involved 48 patients. An interview related to RTW was carried out to identify the factors impacting a patient's decision to return to or resign from work. Functional performance was assessed using the Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scale. (3) Results: Before TKA, 15 individuals (31.25%) qualified for the study did not work and were receiving welfare benefits. After the surgery, 23 individuals (47.9% of those working prior to TKA) did not return to work. The number of those who did not work after TKA increased to 38 (79.17%), which was a significant change. The mean level of functional performance after TKA assessed using KOS-ADL was 75.89. (4) Conclusions: The findings show that the rate of RTW after TKA in Poland is significantly lower than that in other countries. The reasons for this situation, as shown in the study, may be related to the lack of an occupational rehabilitation system, resulting in a paucity of information about the possibility to return to work and about opportunities for retraining.
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Affiliation(s)
| | | | | | | | | | - Agnieszka Guzik
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (Ł.K.); (J.J.); (L.P.)
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Jianlu T, Feng L, Wentao C, Hammouda HIM, Ismailova MS, Shabanova ZA, Efendieva AS. [Total knee replacement in different age groups]. Khirurgiia (Mosk) 2024:45-50. [PMID: 38888018 DOI: 10.17116/hirurgia202406145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To evaluate the efficacy and quality of life in long-term period (1 year) after total knee replacement in various age groups. MATERIAL AND METHODS We studied 134 patients after unilateral primary total knee replacement. The KOOS and SF-36 questionnaires were used to assess the therapeutic effect (functionality and symptoms) and quality of life in patients with knee osteoarthritis. RESULTS At baseline, group I (young patients) had low KOOS pain scores (39.42±16.42), function scores (50.18±19.16) and QoL scores (18.2±15.9) compared to other age groups. A year after surgery, group I (<55 years) had significantly lower KOOS scores of pain, function and quality of life compared to group III (>65 years). Multiple regression analysis showed that age was a significant predictor of pain, but not a function after a year. CONCLUSION Total knee replacement gives a noticeable improvement in pain, functionality and quality of life in all age groups. However, there are significant age-related differences in preoperative assessment of pain, quality of life and mental health, as well as in final indicators of postoperative pain and quality of life. Indeed, young patients (<50 years) report more intense pain and worse quality of life. These data may be used in clinical practice to improve decision-making and patient expectations before total knee replacement.
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Affiliation(s)
- T Jianlu
- Volgograd State Medical University, Volgograd, Russia
| | - L Feng
- The Third People's Hospital of Xiao Shan Hangzhou, Hangzhou, China
| | - C Wentao
- Shunyi District Hospital, Beijing, China
| | | | - M S Ismailova
- Dagestan State Medical University, Makhachkala, Russia
| | - Z A Shabanova
- Dagestan State Medical University, Makhachkala, Russia
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Ayers DC, Yousef M, Yang W, Zheng H. Age-Related Differences in Pain, Function, and Quality of Life Following Primary Total Knee Arthroplasty: Results from a FORCE-TJR Cohort. J Arthroplasty 2023:S0883-5403(23)00350-9. [PMID: 37121490 DOI: 10.1016/j.arth.2023.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION The impact of age on patient outcomes after total knee arthroplasty (TKA) remains controversial. Age has shown no effect on outcome in some studies, while others have reported better or worse outcome in younger patients. The aims of this study were to determine the differences in pain, function, and quality of life reported one-year after TKA across different age groups. METHODS A prospective, multi-center cohort of 11,602 unilateral primary TKA patients was evaluated. Demographic data, comorbid conditions, and patient-reported outcome measures (PROMs) including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS JR, and Short-Form health survey (12-item) were collected pre- and at one-year postoperatively. Descriptive statistics were generated, stratified by age [< 55 years (younger adult), 55 to 64 years (older adult), 65 to 74 years (early elder), and ≥ 75 years (late elder)], and differences in pain, function, and quality of life among the four age groups were evaluated using Chi-square and Kruskal-Wallis tests. Multivariate regression models with 95% confidence interval (CI) were performed to determine if age was predictive for KOOS pain and function scores. RESULTS Prior to surgery, younger patients (< 55 years) reported worse KOOS pain (39), function (50), and quality of life (18) scores with poor mental health score (47) than other older patient groups. The mean pre-op score differences across the age groups in the KOOS total score (9.37), KOOS pain (11.61), KOOS-12 pain (10.14), and KOOS/KOOS-12 QoL (12.60) reached the calculated minimal clinically important difference (MCID). At one-year after TKA, younger patients (< 55 years) reported lower KOOS pain, function, and quality of life scores when compared to older patients (≥ 75 years). The differences in one-year postop scores among the 4 age groups (ranging from 4.0 to 12.2) reached the MCID for pain (10.4) and quality of life (12.2). Younger patients (< 55 years) achieved higher baseline to one-year pain (36.8 points), function (30.3 points), and quality of life (40.7 points) score changes when compared to older patients ≥ 75 years. Although statistically significant, the differences in score changes among the age groups were clinically irrelevant. The multivariate regression analyses showed that age was a significant predictor for pain, but not for function at one year where KOOS pain score was predicted to be higher (less pain) (β =6.17; 95% CI (4.12- 8.22) (P<0.001) in older patients (≥ 75 years) when compared to younger patients (< 55 years). CONCLUSION A TKA provides a dramatic improvement in pain, function, and quality of life in all age groups. However, there are age-related clinically significant differences in pre-operative pain, quality of life, and mental health and in final post-operative pain and quality of life scores with younger patients (< 55 years) reporting more pain, less quality of life, and worse pre-operative mental health. The PROM data presented here can be used clinically to improve shared decision making and patient expectations prior to TKA.
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Affiliation(s)
- David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Mohamed Yousef
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
| | - Wenyun Yang
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA
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González-Sáenz-de-Tejada M, Quintana JM, Arenaza JC, Azcarate-Garitano JR, Esnaola-Guisasola PM, García-Sánchez I, Baguer-Antonio A, Bilbao-González A. Long-term health related quality of life in total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:327. [PMID: 37098518 PMCID: PMC10127408 DOI: 10.1186/s12891-023-06399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND To analyze evolution and factors related with greater gains in Health Related Quality of Life (HRQOL) and with a greater probability of exceed their corresponding minimal clinically important differences (MCID) in patients with Osteoarthritis of the knee, undergoing total knee arthroplasty (TKA) at long-term. METHODS Data were obtained from two previously recruited multicenter cohorts of patients who underwent TKA in the Basque Country. Patients were follow-up at 6 months and 10 years after surgery. Patients completed specific and generic HRQOL questionnaires plus sociodemographic, and clinical data at 10 years. Associations were analysed using linear and logistic regression models. RESULTS A total of 471 patients responded at 10-year follow-up. The multivariable analysis showed that low preoperative HRQOL scores, higher age, higher BMI, some comorbidities and readmissions at 6 months were associated with less gains in HRQOL. Apart from aforementioned, to have a peripheral vascular disease (odd ratio 0.49 (95% CI, 0.24-0.99)), complications (odd ratio 0.31 (95% CI, 0.11-0.91)), and readmissions within 6 months of discharge (odd ratio 2.12 (95% CI, 1.18-3.80)) were associated with a lower probability of exceeding the MCID. The effect sizes (ESs) of changes from baseline to 6 months (range, 1.20-1.96) and to 10 years (range, 1.54-1.99) were large in all dimensions, nevertheless the ESs from 6 months to 10 years were not appreciable for pain (ES = 0.03) or stiffness (ES = 0.09), and small for function (ES = 0.30). CONCLUSIONS Low preoperative HRQOL scores, to be elderly, severe obesity, the presence of some comorbidities -depression and rheumatology disease-, having readmissions or complications and not having rehabilitation of discharge, are good predictors of long-term lower gains in HRQOL. Some other non-registered parameters of the follow-up may also influence those outcomes. KEY INDEXING TERMS (MESH TERMS) Health-Related Quality of Life, Knee Arthroplasty, Total, Osteoarthritis.
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Affiliation(s)
- Marta González-Sáenz-de-Tejada
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
- Osakidetza Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Bilbao, Spain.
- Hospital Universitario de Basurto. Unidad de Investigación, Jado 4º Planta. Avda. Montevideo 18, Bilbao, 48013, Bizkaia, Spain.
| | - Jose M Quintana
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Bilbao, Spain
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, Spain
| | - Juan C Arenaza
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Osakidetza Basque Health Service, Traumatology and Orthopedic Surgery Service, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - Jesús R Azcarate-Garitano
- Osakidetza Basque Health Service, Mendaro Hospital, Traumatology and Orthopedic Surgery Service, Mendaro, Spain
| | - Pedro M Esnaola-Guisasola
- Osakidetza Basque Health Service, Traumatology and Orthopedic Surgery Service, Donostia University Hospital, Donostia, Gipuzkoa, Spain
| | - Isidoro García-Sánchez
- Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Traumatology and Orthopedic Surgery Service, Galdakao, Bizkaia, Spain
| | - Alejandro Baguer-Antonio
- Osakidetza Basque Health Service, Traumatology and Orthopedic Surgery Service, Donostia University Hospital, Donostia, Gipuzkoa, Spain
| | - Amaia Bilbao-González
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Osakidetza Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Bilbao, Spain
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Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Noseworthy TW. Patient acceptable symptom state (PASS): thresholds for the EQ-5D-5L and Oxford hip and knee scores for patients with total hip and knee replacement. Qual Life Res 2023; 32:519-530. [PMID: 36367656 DOI: 10.1007/s11136-022-03287-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To define patient acceptable symptom state (PASS) cut-off values for the EQ-5D-5L and Oxford hip (OHS) and knee (OKS) scores 6 and 12 months after total hip (THR) or knee (TKR) replacement. To compare PASS cut-off values for the EQ-5D-5L scored using: (1) the Canadian value set, (2) the crosswalk value set, and (3) the equal weighted Level Sum Score (LSS). METHODS We mailed questionnaires to consecutive patients following surgeon referral for primary THR or TKR and at 6 and 12 months post-surgery. Patient reported outcome measures (PROMs) were the EQ-5D-5L, the OHS, and OKS. We assessed PASS cut-off values for PROMs using percentile and ROC methods, with the Youden Index. RESULTS Five hundred forty-two surgical patients (mean age, 64 years, 57% female, 49% THR) completed baseline and 12-month questionnaires. 89% of THR and 81% of TKR patients rated PASS as acceptable at 12 months. PASS cut-off values for THR for the EQ-5D-5L (Canadian) were 0.85 (percentile) and 0.84 (Youden) at 12 months. Cut-off values were similar for the LSS (0.85 and 0.85) and lower for the crosswalk value set (0.74 and 0.73), respectively. EQ-5D-5L cut-off values for TKR were Canadian, 0.77 (Percentile) and 0.78 (Youden), LSS, 0.75 and 0.80, and crosswalk, 0.67 and 0.74, respectively. Cut-off values 6 and 12 months post-surgery ranged from 38 to 39 for the OHS, and 28 to 36 for the OKS (range 0 worst to 48 best). CONCLUSION PASS cut-off values for the EQ-5D-5L and Oxford scores varied, not only between methods and timing of assessment, but also by different EQ-5D-5L value sets, which vary between countries. Because of this variation, PASS cut-off values are not necessarily generalizable to other populations of TJR patients. We advise caution in interpreting PROMs when using EQ-5D-5L PASS cut-off values developed in different countries. A standardization of methods is needed before published cut-off values can be used with confidence in other populations.
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Affiliation(s)
- Barbara L Conner-Spady
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Eric Bohm
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Concordia Hip and Knee Institute, 310-1155 Concordia Avenue, Winnipeg, MB, R2K 2M9, Canada
| | - Michael J Dunbar
- Department of Orthopaedic Surgery, Dalhousie University, 1796 Summer Street, Suite 4822, Halifax, NS, B3H 4R2, Canada
| | - Lynda Loucks
- Concordia Hip and Knee Institute, 310-1155 Concordia Avenue, Winnipeg, MB, R2K 2M9, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Validation and interval scale transformation of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients undergoing knee arthroplasty, using the Rasch model. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100322. [PMID: 36601334 PMCID: PMC9805970 DOI: 10.1016/j.ocarto.2022.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Interval scale reduce measurement bias compared to ordinal scale. We aimed to evaluate the fit of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to the Rasch model and derive the transformation table for interval scale measurement. Methods Data from osteoarthritis patients listed for knee arthroplasty (KA) pre-operatively, and at 6- and 12- months post-operative was used. WOMAC was calibrated for fit to the Rasch model for monotonicity, homogeneity, local item independence and absence of differential item functioning (DIF) in a randomly selected 900 patients, 300 from each time point; parameter estimates were then imported into the full data set. Responsiveness was reported through Standard Error of Measurement (SEM); Smallest Detectable Difference (SDD), %SDD and effect sizes (ES) between baseline and 6-months. WOMAC was transformed from ordinal to interval values. Results 1136 patients (mean age 65.9 years, 69.9% female) were included. WOMAC pain (0-20), function (0-68) and total scores (0-96) had adequate fit to Rasch model with good reliability (Person Separation Index: 0.76, 0.80 and 0.79). No item deletion was required. The SEM, SDD, %SDD and ES of WOMAC total were 4.4, 6.9, 10.1, and 1.97. No significant DIF was seen for age, sex, body mass index, type of KA, languages, and education level. WOMAC pain, function and total scores were transformed to interval scales. Conclusion WOMAC total, pain and function scales had adequate fit to the Rasch model, providing unidimensional measure with good reliability and responsiveness. Transformation of WOMAC to interval scale measurement is applicable to other studies.
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Ferreira AM, Salim R, Fogagnolo F, de Oliveira LFL, Riberto M, Kfuri M. The Value of a Standardized Knee Functional Assessment in Predicting the Outcomes of Total Knee Arthroplasty. J Knee Surg 2022; 35:1126-1131. [PMID: 33511585 DOI: 10.1055/s-0040-1722321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Questionnaires and physical tests are tools to determine the ability of an individual to perform tasks of the daily living. In our institution, a standardized knee performance evaluation including patient-reported outcome measures (PROMs) and physical performance tests has been applied to all patients undergoing total knee arthroplasty (TKA). Our goal was to identify which preoperative tools influence the outcomes of a TKA and if physical performance tests can be of value if used along with PROMs in predicting functional outcomes. Classification and regression tree was used to analyze which preoperative factors influence function after TKA. Western Ontario and McMaster Universities Arthritis Index (WOMAC) function (WOMAC-F), 6-minute walk test (6MWT), and timed up and go (TUG) test at the 12th postoperative month were the dependent variables. Age, body mass index, preoperative WOMAC function and pain score, muscle strength, 6MWT, and TUG test score were used as preoperative predictors of dependent variables. TUG ≤19.3 seconds and age <62 years were preoperative predictors of better scores in the WOMAC-F (5.5). Strength of extensor muscles of the nonoperated knee ≥99.43 N·m/kg and 6MWT> 328 m were preoperative predictors of a better postoperative 6MWT (499 m). TUG <12.3 seconds and 6MWT ≥421 m were preoperative predictors of better postoperative TUG (7.3 seconds). Preoperative performance in physical tests had an influence on postoperative outcome scores than PROMs after TKA. Less age, good muscular strength, greater capacity of walking, and smaller TUG times were associated with better outcomes.
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Affiliation(s)
- Aline Miranda Ferreira
- Departament of Health Care, Rehabilitation Center of the Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Rodrigo Salim
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Luciano Fonseca Lemos de Oliveira
- Departament of Health Care, Rehabilitation Center of the Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Marcelo Riberto
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Mauricio Kfuri
- Departament of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Kunze KN, Fontana MA, MacLean CH, Lyman S, McLawhorn AS. Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty. J Bone Joint Surg Am 2022; 104:345-352. [PMID: 34958538 DOI: 10.2106/jbjs.21.00550] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA. METHODS A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ≥70 years of age), sex (men or women), body mass index (BMI; <30 or ≥30 kg/m2), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ≥50). RESULTS The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores (≥50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ≥70 years of age, but was equivalent for the KOOS JR. CONCLUSIONS The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively. The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mark A Fontana
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY.,Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Catherine H MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Stephen Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
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Lee SH, Kim DH, Lee YS. Is there an optimal age for total knee arthroplasty?: A systematic review. Knee Surg Relat Res 2020; 32:60. [PMID: 33198817 PMCID: PMC7667791 DOI: 10.1186/s43019-020-00080-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to elucidate the optimal age for patients undergoing total knee arthroplasty (TKA), to optimize the balance between the benefits and risks by analyzing patient-reported outcome measurements (PROM), revision rate, and mortality according to age. MATERIALS AND METHODS A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data were extracted according to the following: study design, patients enrolled, patient age at the time of surgery, follow-up period, PROM, revision rate, and mortality. RESULTS Thirty-nine articles were included in the final analysis. The results were inconsistent in the PROM analysis, but there was consensus that PROM were good in patients in their 70s . In the revision rate analysis, there was consensus that the revision rate tends to increase in TKA in younger patients, but no significant difference was observed in patients > 70 years of age. In the mortality analysis, there was consensus that the mortality was not significantly different in patients < 80 years of age, but tended to increase with age. CONCLUSION This systematic review shows that the PROM were good when TKA was performed in patients between 70 and 80 years of age; the best PROM could be achieved around 70 years of age, and no significant difference in the revision or mortality rates was observed between 70 and 80 years of age; however, mortality tended to increase with age. Therefore, the early 70s could be recommended as an optimal age to undergo TKA.
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Affiliation(s)
- Seung Hoon Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea.
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Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study. Int J Oral Maxillofac Surg 2020; 50:948-955. [PMID: 33162296 DOI: 10.1016/j.ijom.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.
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Which Preoperative Factors are Associated with Not Attaining Acceptable Levels of Pain and Function After TKA? Findings from an International Multicenter Study. Clin Orthop Relat Res 2020; 478:1019-1028. [PMID: 32039954 PMCID: PMC7170689 DOI: 10.1097/corr.0000000000001162] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although TKA is a common and proven reliable procedure for treating end-stage knee osteoarthritis, a minority of patients still do not achieve satisfactory levels of pain relief and functional improvement. Even though several studies have attempted to identify patients at risk of having poor clinical outcomes, few have approached this issue by considering the outcome of the patient-acceptable symptom state (PASS), defined as the value on a patient-reported outcome measure scale above which the patient deems their current symptom state acceptable. QUESTIONS/PURPOSES (1) What is the proportion of patients who do not attain the PASS in pain and function at 1 year after TKA? (2) Which preoperative patient factors are associated with not achieving the PASS in pain at 1 year after TKA? (3) Which preoperative patient factors are associated with not achieving the PASS in function at 1 year after TKA? METHODS This retrospective study is a secondary analysis of the 1-year follow-up data from a prospective, international, multicenter study of a single TKA system. Inclusion criteria for that study were patients diagnosed with primary osteoarthritis or post-traumatic arthritis and who were able to return for follow-up for 10 years; exclusion criteria were infection, osteomyelitis, and failure of a previous joint replacement. Between 2011 and 2014, 449 patients underwent TKA at 10 centers in five countries. At 1 year, 13% (58 of 449) were lost to follow-up, 2% could not be analyzed (eight of 449; missing 1-year KOOS), leaving 85% (383 of 449) for analysis here. The primary outcomes were not surpassing evidence-derived PASS thresholds in the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain and Activities in Daily Living (ADL) sub-scores. Multivariate binary logistic regressions considering preoperative demographic, radiographic, and patient-reported outcome measure data were constructed using a forward stepwise elimination algorithm to reach the simplest best-fit regression models. RESULTS At 1 year after TKA, 38% of the patients (145 of 383) did not reach the PASS in KOOS Pain, 36% (139 of 383) did not reach the PASS in KOOS ADL, and 29% (110 of 383) did not achieve the PASS in either KOOS Pain or ADL. After controlling for potentially confounding variables such as gender, age, BMI, and comorbidity scores, we found that men (odds ratio 2.09; p = 0.01), and patients with less-than-advanced radiographic osteoarthritis (OR 2.09; p = 0.01) were strongly associated with not achieving the PASS in pain. After controlling for the same potentially confounding variables, we found that patients with less-than-advanced radiographic osteoarthritis (OR 2.09; p = 0.01) were also strongly associated with not achieving the PASS in function. CONCLUSIONS We found that patients with less severe osteoarthritis were much less likely to attain the PASS in pain and function at 1 year after TKA, and that men were much less likely to achieve the PASS in pain at 1 year after TKA. Based on these findings, surgeons should strongly consider delaying surgery in patients who present with less-than-severe osteoarthritis, with increased caution in men. Surgeons should counsel their patients on their expectations and their chances of achieving meaningful levels of pain and functional improvement. Future regional and national registry studies should assess the true proportion of patients attaining PASS in pain and function after TKA and confirm if the preoperative factors identified in this study remain significant in larger, more diverse patient populations. LEVEL OF EVIDENCE Level III, therapeutic study.
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Felix J, Becker C, Vogl M, Buschner P, Plötz W, Leidl R. Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty - results from a German prospective cohort study. Health Qual Life Outcomes 2019; 17:180. [PMID: 31815627 PMCID: PMC6902559 DOI: 10.1186/s12955-019-1237-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background Evaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL. Methods Baseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation. Results One hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply. Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6). Conclusion On average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.
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Affiliation(s)
- Julia Felix
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.
| | - Christian Becker
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Matthias Vogl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany.,Klinikum rechts der Isar, Technical University Munich, 81675, Munich, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.,Institute for Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28 RG, 80539, Munich, Germany
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van Zaanen Y, van Geenen RCI, Pahlplatz TMJ, Kievit AJ, Hoozemans MJM, Bakker EWP, Blankevoort L, Schafroth MU, Haverkamp D, Vervest TMJS, Das DHPW, van der Weegen W, Scholtes VA, Frings-Dresen MHW, Kuijer PPFM. Three Out of Ten Working Patients Expect No Clinical Improvement of Their Ability to Perform Work-Related Knee-Demanding Activities After Total Knee Arthroplasty: A Multicenter Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:585-594. [PMID: 30539374 PMCID: PMC6675779 DOI: 10.1007/s10926-018-9823-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients' expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0-100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients' expected WORQ score (Median = 75, IQR 60-86) was significantly (p < 0.01) higher than their preoperative WORQ score (Median = 44, IQR 35-56). A clinical improvement in ability to perform work-related knee-demanding activities was expected by 72% of the patients, while 28% of the patients expected no clinical improvement or even worse ability to perform work-related knee-demanding activities 6 months after TKA. Of the patients, 34% expected severe difficulty in kneeling, 30% in crouching and 17% in clambering 6 months after TKA. Conclusions Most patients have high expectations, especially regarding activities involving deep knee flexion. Remarkably, three out of ten patients expect no clinical improvement or even a worse ability to perform work-related knee-demanding activities 6 months postoperatively compared to their preoperative status. Therefore, addressing patients expectations seems useful in order to assure realistic expectations regarding work activities.
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Affiliation(s)
- Yvonne van Zaanen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Thijs M J Pahlplatz
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco J M Hoozemans
- CORAL - Center for Orthopaedic Research Alkmaar, Department of Orthopaedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Eric W P Bakker
- Master Evidence Based Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Slotervaart Center of Orthopedic Research and Education (SCORE), MC Slotervaart, Amsterdam, The Netherlands
| | - Ton M J S Vervest
- Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, The Netherlands
| | - Dirk H P W Das
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Walter van der Weegen
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | | | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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