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Salman LA, Khatkar H, Al-Ani A, Alzobi OZ, Abudalou A, Hatnouly AT, Ahmed G, Hameed S, AlAteeq Aldosari M. Reliability of artificial intelligence in predicting total knee arthroplasty component sizes: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:747-756. [PMID: 38010443 PMCID: PMC10858112 DOI: 10.1007/s00590-023-03784-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE This systematic review aimed to investigate the reliability of AI predictive models of intraoperative implant sizing in total knee arthroplasty (TKA). METHODS Four databases were searched from inception till July 2023 for original studies that studied the reliability of AI prediction in TKA. The primary outcome was the accuracy ± 1 size. This review was conducted per PRISMA guidelines, and the risk of bias was assessed using the MINORS criteria. RESULTS A total of four observational studies comprised of at least 34,547 patients were included in this review. A mean MINORS score of 11 out of 16 was assigned to the review. All included studies were published between 2021 and 2022, with a total of nine different AI algorithms reported. Among these AI models, the accuracy of TKA femoral component sizing prediction ranged from 88.3 to 99.7% within a deviation of one size, while tibial component sizing exhibited an accuracy ranging from 90 to 99.9% ± 1 size. CONCLUSION This study demonstrated the potential of AI as a valuable complement for planning TKA, exhibiting a satisfactory level of reliability in predicting TKA implant sizes. This predictive accuracy is comparable to that of the manual and digital templating techniques currently documented in the literature. However, future research is imperative to assess the impact of AI on patient care and cost-effectiveness. LEVEL OF EVIDENCE III PROSPERO registration number: CRD42023446868.
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Affiliation(s)
- Loay A Salman
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Osama Z Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abedallah Abudalou
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ashraf T Hatnouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohamed AlAteeq Aldosari
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Cohen D, Greenberg A, Maliarov A, Seligman D, Backstein D. Long-term outcomes of the Nexgen © posterior stabilized knee: minimum 15 year follow-safe and effective. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2943-2949. [PMID: 36912950 PMCID: PMC10009351 DOI: 10.1007/s00590-023-03514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Studying long-term survivorship and functional outcomes for specific prostheses is critical for elucidating areas in need of design improvement. This study reports the long-term of the NexGen Posterior Stabilized (PS) Total Knee implant (TKA) (Zimmer Biomet, Warsaw IN) Performed by a single surgeon. METHODS Data from patients treated with the NexGen PS TKA between January 2003 and December 2005 with a minimal follow-up of 15 years was collected from a prospectively collected database. Survivorship rates and Oxford Knee Scores (OKS) were obtained for those patients available for follow-up. RESULTS Ninety-five patients met the inclusion criteria during the study period. OKS was available for 44 (46%) patients. Ten patients required revision surgery (10.52%). Implant-specific survivorship of all cases that were reviewed was 98%. Survivorship of implants in patients that we were able to reach, or deceased patients was 93%. The average Oxford Knee Score was 39.1 (14-48. SD ± 7.70) with 48 being the maximal score. CONCLUSION Despite some concerns about durability of this implant, good longevity and function was demonstrated. At a minimum of 15 years follow-up in this cohort. Given these results design features of this system should be considered for future generations of implants.
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Affiliation(s)
- Daniel Cohen
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Arieh Greenberg
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Anton Maliarov
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Seligman
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Backstein
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
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Dorr MC, van Hof KS, Jelsma JGM, Dronkers EAC, de Jong RJB, Offerman MPJ, de Bruijne MC. Quality improvements of healthcare trajectories by learning from aggregated patient-reported outcomes: a mixed-methods systematic literature review. Health Res Policy Syst 2022; 20:90. [PMID: 35978425 PMCID: PMC9387033 DOI: 10.1186/s12961-022-00893-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background In healthcare, analysing patient-reported outcome measures (PROMs) on an aggregated level can improve and regulate healthcare for specific patient populations (meso level). This mixed-methods systematic review aimed to summarize and describe the effectiveness of quality improvement methods based on aggregated PROMs. Additionally, it aimed to describe barriers, facilitators and lessons learned when using these quality improvement methods. Methods A mixed-methods systematic review was conducted. Embase, MEDLINE, CINAHL and the Cochrane Library were searched for studies that described, implemented or evaluated a quality improvement method based on aggregated PROMs in the curative hospital setting. Quality assessment was conducted via the Mixed Methods Appraisal Tool. Quantitative data were synthesized into a narrative summary of the characteristics and findings. For the qualitative analysis, a thematic synthesis was conducted. Results From 2360 unique search records, 13 quantitative and three qualitative studies were included. Four quality improvement methods were identified: benchmarking, plan-do-study-act cycle, dashboards and internal statistical analysis. Five studies reported on the effectiveness of the use of aggregated PROMs, of which four identified no effect and one a positive effect. The qualitative analysis identified the following themes for facilitators and barriers: (1) conceptual (i.e. stakeholders, subjectivity of PROMs, aligning PROMs with clinical data, PROMs versus patient-reported experience measures [PREMs]); (2a) methodological—data collection (i.e. choice, timing, response rate and focus); (2b) methodological—data processing (i.e. representativeness, responsibility, case-mix control, interpretation); (3) practical (i.e. resources). Conclusion The results showed little to no effect of quality improvement methods based on aggregated PROMs, but more empirical research is needed to investigate different quality improvement methods. A shared stakeholder vision, selection of PROMs, timing of measurement and feedback, information on interpretation of data, reduction of missing data, and resources for data collection and feedback infrastructure are important to consider when implementing and evaluating quality improvement methods in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00893-4. What is already known on this topic The aggregated patient-reported outcome measures (PROMs) can be used for analytical and organizational aspects of improving and regulating healthcare, but there is little empirical evidence regarding the effectiveness of aggregated PROMS. What this study adds This study adds a detailed overview of the types of quality improvement methods and recommendations for implementation in practice. How this study might affect research, practice or policy Researchers and policy-makers should consider the barriers, facilitators and lessons learned for future implementation and evaluation of quality improvement methods, as presented in this manuscript, to further advance this field.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - K S van Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - J G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - E A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - M P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - M C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Prats-Uribe A, Kolovos S, Berencsi K, Carr A, Judge A, Silman A, Arden N, Petersen I, Douglas IJ, Wilkinson JM, Murray D, Valderas JM, Beard DJ, Lamb SE, Ali MS, Pinedo-Villanueva R, Strauss VY, Prieto-Alhambra D. Unicompartmental compared with total knee replacement for patients with multimorbidities: a cohort study using propensity score stratification and inverse probability weighting. Health Technol Assess 2021; 25:1-126. [PMID: 34812138 DOI: 10.3310/hta25660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although routine NHS data potentially include all patients, confounding limits their use for causal inference. Methods to minimise confounding in observational studies of implantable devices are required to enable the evaluation of patients with severe systemic morbidity who are excluded from many randomised controlled trials. OBJECTIVES Stage 1 - replicate the Total or Partial Knee Arthroplasty Trial (TOPKAT), a surgical randomised controlled trial comparing unicompartmental knee replacement with total knee replacement using propensity score and instrumental variable methods. Stage 2 - compare the risk benefits and cost-effectiveness of unicompartmental knee replacement with total knee replacement surgery in patients with severe systemic morbidity who would have been ineligible for TOPKAT using the validated methods from stage 1. DESIGN This was a cohort study. SETTING Data were obtained from the National Joint Registry database and linked to hospital inpatient (Hospital Episode Statistics) and patient-reported outcome data. PARTICIPANTS Stage 1 - people undergoing unicompartmental knee replacement surgery or total knee replacement surgery who met the TOPKAT eligibility criteria. Stage 2 - participants with an American Society of Anesthesiologists grade of ≥ 3. INTERVENTION The patients were exposed to either unicompartmental knee replacement surgery or total knee replacement surgery. MAIN OUTCOME MEASURES The primary outcome measure was the postoperative Oxford Knee Score. The secondary outcome measures were 90-day postoperative complications (venous thromboembolism, myocardial infarction and prosthetic joint infection) and 5-year revision risk and mortality. The main outcome measures for the health economic analysis were health-related quality of life (EuroQol-5 Dimensions) and NHS hospital costs. RESULTS In stage 1, propensity score stratification and inverse probability weighting replicated the results of TOPKAT. Propensity score adjustment, propensity score matching and instrumental variables did not. Stage 2 included 2256 unicompartmental knee replacement patients and 57,682 total knee replacement patients who had severe comorbidities, of whom 145 and 23,344 had linked Oxford Knee Scores, respectively. A statistically significant but clinically irrelevant difference favouring unicompartmental knee replacement was observed, with a mean postoperative Oxford Knee Score difference of < 2 points using propensity score stratification; no significant difference was observed using inverse probability weighting. Unicompartmental knee replacement more than halved the risk of venous thromboembolism [relative risk 0.33 (95% confidence interval 0.15 to 0.74) using propensity score stratification; relative risk 0.39 (95% confidence interval 0.16 to 0.96) using inverse probability weighting]. Unicompartmental knee replacement was not associated with myocardial infarction or prosthetic joint infection using either method. In the long term, unicompartmental knee replacement had double the revision risk of total knee replacement [hazard ratio 2.70 (95% confidence interval 2.15 to 3.38) using propensity score stratification; hazard ratio 2.60 (95% confidence interval 1.94 to 3.47) using inverse probability weighting], but half of the mortality [hazard ratio 0.52 (95% confidence interval 0.36 to 0.74) using propensity score stratification; insignificant effect using inverse probability weighting]. Unicompartmental knee replacement had lower costs and higher quality-adjusted life-year gains than total knee replacement for stage 2 participants. LIMITATIONS Although some propensity score methods successfully replicated TOPKAT, unresolved confounding may have affected stage 2. Missing Oxford Knee Scores may have led to information bias. CONCLUSIONS Propensity score stratification and inverse probability weighting successfully replicated TOPKAT, implying that some (but not all) propensity score methods can be used to evaluate surgical innovations and implantable medical devices using routine NHS data. Unicompartmental knee replacement was safer and more cost-effective than total knee replacement for patients with severe comorbidity and should be considered the first option for suitable patients. FUTURE WORK Further research is required to understand the performance of propensity score methods for evaluating surgical innovations and implantable devices. TRIAL REGISTRATION This trial is registered as EUPAS17435. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Albert Prats-Uribe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Spyros Kolovos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Klara Berencsi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Medical Research Council Lifecourse Epidemiological Unit, University of Southampton, Southampton, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Research Committee, National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, Hemel Hempstead, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Jose M Valderas
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,University of Exeter Medical School, Institute of Health Research, College of Medicine and Health, Exeter, UK
| | - M Sanni Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Victoria Y Strauss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
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Ashraf Y, Iqbal HJ, Senevirathana S, Ashraf T. Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis? J Orthop Surg (Hong Kong) 2021; 28:2309499020975553. [PMID: 33272080 DOI: 10.1177/2309499020975553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND AIM Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. METHODS A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. RESULTS At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). CONCLUSION This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune's predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.
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Baryeh K, Maillot C, Gummaraju A, Rivière C. Disappointing Relationship between Functional Performance and Patient Satisfaction of UKA Patients: A Cross Sectional Study. Orthop Traumatol Surg Res 2021; 107:102865. [PMID: 33636415 DOI: 10.1016/j.otsr.2021.102865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Following a Unicompartmental knee arthroplasty (UKA) satisfaction is often conflated with functional outcome. Recent studies have shown that satisfaction is not linked to functional outcome. The research questions were: (1) what is the relationship between satisfaction and functional performance and quality of life (absolute and gain values) after UKA? And (2) what is the level of satisfaction, function, and quality of life after UKA? HYPOTHESIS There is a poor relationship between functional performance and patient satisfaction following UKA. METHODS This was a retrospective study using a locally held arthroplasty register to identify patients who had undergone UKA between 2004 and 2017. Patient reported outcome measures (PROMs) were collected prospectively and included EQ-5D, Oxford Knee Score (OKS) and satisfaction score (based on a visual analogue score with 0 being worst and 100 being best). Patients with a complete set of pre-operative and 2-year post-operative outcome scores were included. Patients who subsequently underwent revision surgery were excluded. 1638 patients were identified, of which 896 were eligible for inclusion. The average age was 66.7 years old, with 46.3% of patients being female. RESULTS There was a moderate to strong correlation between the absolute or relative values for OKS and the patient satisfaction following UKA (r=0.705 and r=0.522, respectively). The average pre-operative scores improved from a median of 23 (IQR 18-28) to 43 (IQR 35-46) (p<0.001) and from a median of 0.62 (IQR 0.186-0.691) to 0.85 (IQR 0.691 - 1) (p<0.001) for OKS and EQ-5D, respectively. In terms of satisfaction with outcome, 82.6% of patients were very satisfied and 4.4% were dissatisfied (scoring ≥80% and <50%, respectively). At 2 years, the PASS was met or surpassed by 73.1% and 54.9% (OKS and EQ-5D, respectively). The MCID was met or surpassed by 93% and 78% (OKS and EQ-5D, respectively). DISCUSSION/CONCLUSION UKA is a successful procedure generating high levels of patient function and satisfaction. Because patients' OKS and EQ-5D scores may be influenced by comorbidities, those scores are of disappointing predictive value in estimating patient satisfaction, and therefore should not be used as a surrogate to determine the success of the UKA procedure. LEVEL OF EVIDENCE III; Restrospective cohort study.
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Affiliation(s)
- Kwaku Baryeh
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK.
| | - Cedric Maillot
- Service de Chirurgie Orthopedique et Traumatologique Bichat-Beaujon, Assistance Publique Hospitaux de Paris universite Sorbonne Paris Cite, France
| | - Advaith Gummaraju
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK
| | - Charles Rivière
- South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK; The MSK Lab, Imperial College London, Charing Cross Hospital, Charing Cross Campus, W6 8RF London, UK; Centre de l'Arthrose - Clinique de Sport, 4, rue Georges Negrevergne, 33700 Mérignac, France
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Withers K, Palmer R, Lewis S, Carolan-Rees G. First steps in PROMs and PREMs collection in Wales as part of the prudent and value-based healthcare agenda. Qual Life Res 2020; 30:3157-3170. [PMID: 33249539 PMCID: PMC7700742 DOI: 10.1007/s11136-020-02711-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 12/25/2022]
Abstract
Purpose Patients are experts in their own health and should be treated as equal partners in their care. Patient-reported outcome measures (PROMs) are an effective way of gathering patient feedback and can facilitate effectiveness and cost-effectiveness analysis to improve decision making and service improvement. The PROMs, PREMs & Effectiveness Programme was initiated in 2016 and aimed to develop an electronic platform to facilitate collection of PROMs and Patient-reported experience measures (PREMs) from secondary care patients across Wales. Methods We worked with all Health Boards in Wales, the NHS Wales Informatics Service (NWIS), and Cedar (a healthcare technology research centre) to identify and meet technical requirements to develop a platform which is fit for purpose. Patient groups were included throughout the development to gather feedback and for extensive testing. Clinical teams helped identify the most appropriate tools, with licences, translations and electronic formatting issues being managed centrally. Results The developed platform is integrated with patient administration systems minimising the need for manual input, with processes in place to allow automatic collection triggers according to nationally agreed schedules. We have over 30 nationally agreed PROMs ‘pathways’ with over 110,000 PROMs collected to date. Responses are fed back to clinicians via the electronic patient record and to each health board via feeds to the national data warehouse, making data easily accessible to different teams, maximising use and application. Discussion The national platform has provided a co-ordinated approach to PROMs collection in Wales, offering an effective means of communicating with patients outside the traditional clinic visit.
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Affiliation(s)
- Kathleen Withers
- Cedar Healthcare Technology Research Centre, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK.
| | - Robert Palmer
- Cedar Healthcare Technology Research Centre, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
| | - Sally Lewis
- Value Based & Prudent Healthcare, Mamhilad House, Mamhilad Park Estate, Pontypool, NP4 0HZ, UK
| | - Grace Carolan-Rees
- Cedar Healthcare Technology Research Centre, Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
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Sindhupakorn B, Numpaisal PO, Thienpratharn S, Jomkoh D. A home visit program versus a non-home visit program in total knee replacement patients: a randomized controlled trial. J Orthop Surg Res 2019; 14:405. [PMID: 31783762 PMCID: PMC6884913 DOI: 10.1186/s13018-019-1412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goals in total knee replacement (TKR) are pain relief, restore functions, and improve quality of life. Surgical outcomes were not related to patients' satisfaction. Low 1-year WOMAC especially in the first 6 weeks and painful TKR related to patient dissatisfied. To improve satisfaction, we created the home visit program (TKR-H) after hospital discharge. INHOMESSS was the rationale for home visit activities. METHODS We recruited 52 TKRs. Four TKRs were excluded. We used simple randomization for 24 patients as a home visit (TKR-H) and 24 patients as a non-home visit (TKR). Patients were evaluated by general demographics, pain intensity scores (VAS), range of motion (ROM), WOMAC, knee scores, and functional scores as a primary objective. A duration for gait aid independent and patient's satisfaction score as secondary objective. The study was 6 weeks after surgery. RESULTS TKR-H and TKR had significant differences in the mean of WOMAC score (88.29 ± 10.66 vs. 68.00 ± 12.47, respectively, P < 0.001), pain score (VAS) (6.25 ± 10.13 vs. 35.67 ± 22.05, respectively, P < 0.001), knee score (81.67 ± 10.08 vs. 68.38 ± 6.45, respectively, P < 0.001), functional score (77.83 ± 4.22 vs. 73.70 ± 7.48, respectively, P = 0.037), and range of motion (107.71 ± 8.47 vs. 98.17 ± 9.57, respectively, P = 0.001). The patient's satisfaction score in TKR-H group (4.71 ± 0.46) was significantly higher than the TKR group (4.13 ± 0.45) (P < 0.001) and time to gait aid independent (2.75 ± 0.99 vs. 3.71 ± 1.23, respectively, P = 0.005). CONCLUSION Our TKR-H showed better clinical outcomes and satisfaction than non-home visit. The rationale in TKR-H improves satisfaction after total knee replacement. TRIAL REGISTRATION TCTR20190514001.
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Affiliation(s)
- Bura Sindhupakorn
- School of orthopedic, Institute of medicine, Suranaree University of Technology, 111 University Ave, Muang District, Nakhon Ratchasima, Nakhon Ratchasima 30000 Thailand
| | - Piya-on Numpaisal
- School of orthopedic, Institute of medicine, Suranaree University of Technology, 111 University Ave, Muang District, Nakhon Ratchasima, Nakhon Ratchasima 30000 Thailand
| | - Suwittaya Thienpratharn
- School of orthopedic, Institute of medicine, Suranaree University of Technology, 111 University Ave, Muang District, Nakhon Ratchasima, Nakhon Ratchasima 30000 Thailand
| | - Darawan Jomkoh
- School of orthopedic, Institute of medicine, Suranaree University of Technology, 111 University Ave, Muang District, Nakhon Ratchasima, Nakhon Ratchasima 30000 Thailand
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Webb M, Dewan V, Elson D. Functional results following high tibial osteotomy: a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:555-563. [PMID: 29302782 PMCID: PMC5906498 DOI: 10.1007/s00590-017-2112-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023]
Abstract
Introduction High tibial osteotomy (HTO) is an operation used to treat patients with medial compartment knee osteoarthritis. The United Kingdom Knee Osteotomy Registry (UKKOR) has been set up to gather contemporaneous data on HTO throughout the patient journey. UKKOR uses a variety of patient-reported outcome measures (PROMs) to gauge the surgical outcome. Aim The aim of this review is to analyse the published literature that has used PROMs to assess the outcomes following HTO. Methodology Two searches of the literature were performed and compiled highlighting 95 articles of interest. After screening and manual additions, 23 manuscripts were reviewed and appraised using the appropriate Critical Appraisal Skills Programme Checklist (Kai et al. in PLoS Med 4(11):1766–1775, 2007). Results and discussion There is a variety of published literature on HTO with a varied approach to the use of PROMs. Their use has increased recently, and studies have demonstrated that they are appropriate assessment tools for monitoring outcomes following HTO. In all of the studies that compared pre-operative to post-operative PROMs, there have been significant improvements. However, the data are varied due to differing study designs which in some instances have significant limitations. Conclusion PROMs are effective ways to measure outcomes following HTO. They can also be useful in predicting outcome. The heterogeneity of the data and limitations of the study designs limit the transferability of the data. It is therefore important to analyse data from a multi-surgeon, multi-centre source that uses robust and constant pre- and post-operative PROMs.
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Affiliation(s)
- Mark Webb
- Northern Deanery, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY UK
| | - Varun Dewan
- Royal Wolverhampton NHS Trust, Wolverhampton Road, Heath Town, Wolverhampton, WV10 0QP UK
| | - David Elson
- Queen Elizabeth Hospital, Gateshead, NE9 6SX UK
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Peden C, Campbell M, Aggarwal G. Quality, safety, and outcomes in anaesthesia: what's to be done? An international perspective. Br J Anaesth 2017; 119:i5-i14. [DOI: 10.1093/bja/aex346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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White LD, Melhuish TM. The role of infrapatellar fat pad resection in total knee arthroplasty. Ann Rheum Dis 2016; 75:e66. [DOI: 10.1136/annrheumdis-2016-210037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/03/2022]
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