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Choi YS, Chang MJ, Shin YB, Kim TW, Chang CB, Kang SB. The Relationship between Western Ontario and McMaster Universities Osteoarthritis Index Score and Satisfaction after Total Knee Arthroplasty Changes Over Time. J Knee Surg 2024; 37:374-380. [PMID: 37380042 DOI: 10.1055/a-2119-3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
This study aimed to determine whether there was a relationship between preoperative patient-reported outcome measures (PROMs) and satisfaction after total knee arthroplasty (TKA), and whether there was a relationship between the amount of improvement in PROM or final PROM and satisfaction and whether that relationship differed 1 and 2 years after TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and satisfaction of 267 limbs who underwent TKA were analyzed. Logistic regression analysis was performed to determine whether there was a relationship between preoperative WOMAC or improvement in WOMAC or final WOMAC and satisfaction at 1 and 2 years after TKA. Pearson and Filon's z test was performed to determine whether there was a difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. There was no significant relationship between preoperative WOMAC and satisfaction. A higher improvement in WOMAC total score and better final WOMAC total scores at 1 and 2 years after TKA were related to greater satisfaction. At 1 year after TKA, there was no significant difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. However, 2 years after TKA, the final WOMAC function and total score were more related to satisfaction than the amount of improvement in WOMAC function and total score. In the early postoperative period, there was no difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC, whereas over time, the final WOMAC was more related to satisfaction.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Bin Shin
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Sato EH, Treu EA, Froerer DL, Zhang C, O'Neill DC, Cizik AM, Haller JM. Establishing the Patient Acceptable Symptom State Thresholds for Patient-Reported Outcomes after Operatively Treated Tibial Plateau Fractures. J Orthop Trauma 2024; 38:121-128. [PMID: 38117573 DOI: 10.1097/bot.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Define patient-acceptable symptom state (PASS) thresholds and factors affecting PASS thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) following operatively treated tibial plateau fractures. METHODS DESIGN Retrospective cohort. SETTING Single Level I academic trauma center. PATIENT SELECTION CRITERIA All patients (n = 159) who underwent fixation of a tibial plateau fracture from 2016 to 2021 and completed patient-reported outcome measures (PROMs) at minimum 1-year follow-up were enrolled for the study. OUTCOME MEASURES AND COMPARISONS PASS thresholds for global outcome (PASS-Global), pain (PASS-Pain), and function (PASS-Function) were determined using anchor-based questions such as "How satisfied are you today with your injured lower extremity?" with answer choices of very satisfied, satisfied, neutral, unsatisfied, and very unsatisfied. PASS thresholds for each PROM were calculated using 3 methods: (1) 80% specificity, (2) 75th percentile, and (3) Youden Index. RESULTS Sixty percent of patients were satisfied with their global outcome and 53% with function. Using 80% specificity, 75th percentile, and Youden Index, PASS-Global thresholds were 48.5, 44.5, and 47.9 for PROMIS-PF and 56.3, 56.2, and 56.3 for KOOS-QOL, respectively. PASS-Pain threshold for KOOS-Pain was 84.4, 80.6, and 80.6, respectively. PASS-Function thresholds were 48.9, 46.8, and 48 for PROMIS-PF and 94.1, 90.2, and 86.8 for KOOS-ADL, respectively. Younger patients and those with bicondylar fractures or infections were associated with significantly lower PASS-Pain thresholds. Schatzker II fractures, lateral column involvement, or isolated lateral approach resulted in significantly higher PASS-Global and PASS-Function thresholds. CONCLUSIONS This study defines global, functional, and pain PASS thresholds for tibial plateau fractures. Patients with bicondylar fractures, infections, and medial column involvement were more often unsatisfied. These thresholds are valuable references to identify patients who have attained satisfactory outcomes and to counsel patients with risk factors for unsatisfactory outcomes following tibial plateau fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eleanor H Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Vina ER, Patel P, Grest CV, Kwoh CK, Jakiela JT, Bye T, White DK. Does Physical Activity Confound Race Differences in Osteoarthritis-Related Functional Limitation? Arthritis Care Res (Hoboken) 2024; 76:200-207. [PMID: 37518677 DOI: 10.1002/acr.25209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)-related functional limitation. METHODS OA Initiative study participants with or at increased risk of knee OA who wore an accelerometer were included. Race was self-reported. Average time spent in moderate to vigorous physical activity (minutes per day) based on ActiGraph uniaxial accelerometer data was assessed. Functional limitation was based on the following: (1) inability to achieve a community walking speed (1.2 m/s) standard, (2) slow walking speed (<1.0 m/s), and (3) low physical functioning based on a Western Ontario and McMaster Universities OA Index (WOMAC) physical function score greater than 28 of 68. RESULTS African American (AA) participants (n = 226), compared with White participants (n = 1348), had a higher likelihood of developing functional limitation based on various measures. When adjusted for time in moderate to vigorous physical activity, the association between AA race and inability to walk a community walking speed slightly decreased (from relative risk [RR] 2.15, 95% confidence interval [95% CI] 1.64-2.81, to RR 1.99, 95% CI 1.51-2.61). Association between AA race and other measures of functional limitation mildly decreased (slow walking speed: from RR 2.06, 95% CI 1.40-3.01, to RR 1.82, 95% CI 1.25-2.63; low physical functioning: from RR 3.44, 95% CI 1.96-6.03, to RR 3.10, 95% CI 1.79-5.39). When further adjusted for demographic and other clinical variables, only the association between race and low physical functioning (WOMAC) significantly decreased and no longer met statistical significance. CONCLUSION Greater physical activity is unlikely to completely make up for race differences in OA-related functional limitation, and other barriers to health equity need to be addressed.
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Affiliation(s)
- Ernest R Vina
- Temple University, Philadelphia, Pennsylvania, and University of Arizona, Tucson
| | - Puja Patel
- Temple University, Philadelphia, Pennsylvania
| | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
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Sandhu A, Espin-Garcia O, Rockel JS, Lively S, Perry K, Mohamed NN, Raja Rampersaud Y, Perruccio AV, Robin Poole A, Gandhi R, Kapoor M. Association of synovial fluid and urinary C2C-HUSA levels with surgical outcomes post-total knee arthroplasty. Osteoarthritis Cartilage 2024; 32:98-107. [PMID: 37805006 DOI: 10.1016/j.joca.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES After total knee arthroplasty (TKA), ∼30% of knee osteoarthritis (KOA) patients show little symptomatic improvement. Earlier studies have correlated urinary (u) type 2 collagen C terminal cleavage peptide assay (C2C-HUSA), which detects a fragment of cartilage collagen breakdown, with KOA progression. This study determines whether C2C levels in urine, synovial fluid, or their ratio, are associated with post-surgical outcomes. METHODS From a large sample of 489 subjects, diagnosed with primary KOA undergoing TKA, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores were collected at baseline (time of surgery) and one-year post-TKA. Baseline urine (u) and synovial fluid (sf) were analysed using the IBEX-C2C-HUSA assay, with higher values indicating higher amounts of cartilage degradation. For urine, results were normalised to creatinine. Furthermore, subjects' changes in WOMAC scores were categorised based on percent reduction in pain or improvement in function, compared to baseline, such that >66.7%, >33.3 to ≤66.7%, and ≤33.3% denoted "strong", "moderate" and "mild/worse" responses, respectively. Associations of individual biofluid C2C-HUSA levels, or their ratio, with change in WOMAC pain and function scores up to one-year post-TKA, or category of change, were analysed by linear, logistic, or cumulative odds models. RESULTS Higher baseline uC2C-HUSA levels or a lower ratio of baseline sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC pain by linear multivariable modelling [odds ratio -0.40 (95% confidence interval -0.76, -0.05) p = 0.03; 0.36 (0.01, 0.71), p = 0.04, respectively], while sfC2C-HUSA alone was not. However, lower ratios of sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC function [1.37 (0.18, 2.55), p = 0.02], while sfC2C-HUSA and uC2C-HUSA alone were not. Lower ratios of sfC2C-HUSA to uC2C-HUSA were also associated with an increased likelihood of a subject being categorised in a group where TKA was beneficial in both univariable [pain, 0.81 (0.68, 0.96), p = 0.02; function, 0.92 (0.85, 0.99), p = 0.035] and multivariable [pain, 0.81 (0.68, 0.97) p = 0.02; function, 0.92 (0.85, 1.00), p = 0.043] ordinal modelling, while sfC2C-HUSA and uC2C-HUSA alone were not. CONCLUSIONS Overall, ratios of baseline sfC2C-HUSA to uC2C-HUSA, and baseline uC2C-HUSA, may play an important role in studying post-TKA surgical outcomes.
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Affiliation(s)
- Amit Sandhu
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Dalla Lana School of Public Health and Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jason S Rockel
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kimberly Perry
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Nizar N Mohamed
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A Robin Poole
- Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Rajiv Gandhi
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mohit Kapoor
- Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Musbahi O, Collins JE, Yang H, Selzer F, Chen AF, Lange J, Losina E, Katz JN. Assessment of Residual Pain and Dissatisfaction in Total Knee Arthroplasty: Methods Matter. JB JS Open Access 2023; 8:e23.00077. [PMID: 38058510 PMCID: PMC10697603 DOI: 10.2106/jbjs.oa.23.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background Residual pain after total knee arthroplasty (TKA) refers to knee pain after 3 to 6 months postoperatively. The estimates of the proportion of patients who experience residual pain after TKA vary widely. We hypothesized that the variation may stem from the range of methods used to assess residual pain. We analyzed data from 2 prospective studies to assess the proportion of subjects with residual pain as defined by several commonly used metrics and to examine the association of residual pain defined by each metric with participant dissatisfaction. Methods We combined participant data from 2 prospective studies of TKA outcomes from subjects recruited between 2011 and 2014. Residual pain was defined using a range of metrics based on the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain score (0 to 100, in which 100 indicates worst), including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). We also examined combinations of MCID and PASS cutoffs. Subjects self-reported dissatisfaction following TKA, and we defined dissatisfied as somewhat or very dissatisfied at 12 months. We calculated the proportion of participants with residual pain, as defined by each metric, who reported dissatisfaction. We examined the association of each metric with dissatisfaction by calculating the sensitivity, specificity, positive predictive value, and Youden index. Results We analyzed data from 417 subjects with a mean age (and standard deviation) of 66.3 ± 8.3 years. Twenty-six participants (6.2%) were dissatisfied. The proportion of participants defined as having residual pain according to the various metrics ranged from 5.5% to >50%. The composite metric Improvement in WOMAC pain score ≥20 points or final WOMAC pain score ≤25 had the highest positive predictive value for identifying dissatisfied subjects (0.54 [95% confidence interval, 0.35 to 0.71]). No metric had a Youden index of ≥50%. Conclusions Different metrics provided a wide range of estimates of residual pain following TKA. No estimate was both sensitive and specific for dissatisfaction in patients who underwent TKA, underscoring that measures of residual pain should be defined explicitly in reports of TKA outcomes. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Omar Musbahi
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Imperial College London, London, United Kingdom
| | - Jamie E. Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Heidi Yang
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonia F. Chen
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Lange
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
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Li D, Cheng Y, Yuan P, Wu Z, Liu J, Kan J, Zhang K, Wang Z, Zhang H, Zhang G, Xue T, Jia J, Zhai S, Guan Z. Efficacy and safety of flurbiprofen cataplasms versus loxoprofen sodium cataplasms in knee osteoarthritis: a randomized controlled trial. Chin Med J (Engl) 2023; 136:2187-2194. [PMID: 37545031 PMCID: PMC10508367 DOI: 10.1097/cm9.0000000000002797] [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] [Received: 01/23/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Clinical trial evidence is limited to identify better topical non-steroidal anti-inflammatory drugs (NSAIDs) for treating knee osteoarthritis (OA). We aimed to compare the clinical efficacy and safety of flurbiprofen cataplasms (FPC) with loxoprofen sodium cataplasms (LSC) in treating patients with knee OA. METHODS This is an open-label, non-inferiority randomized controlled trial conducted at Peking University Shougang Hospital. Overall, 250 patients with knee OA admitted from October 2021 to April 2022 were randomly assigned to FPC and LSC treatment groups in a 1:1 ratio. Both medications were administered to patients for 28 days. The primary outcome was the change of pain measured by visual analog scale (VAS) score from baseline to day 28 (range, 0-10 points; higher score indicates worse pain; non-inferiority margin: 1 point; superiority margin: 0 point). There were four secondary outcomes, including the extent of pain relief, the change trends of VAS scores, joint function scores measured by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and adverse events. RESULTS Among 250 randomized patients (One patient without complete baseline record in the flurbiprofen cataplasms was excluded; age, 62.8 ± 10.5 years; 61.4% [153/249] women), 234 (93.6%) finally completed the trial. In the intention-to-treat analysis, the decline of the VAS score for the 24-h most intense pain in the FPC group was non-inferior, and also superior to that in the LSC group (differences and 95% confidence interval, 0.414 (0.147-0.681); P <0.001 for non-inferiority; P = 0.001 for superiority). Similar results were observed of the VAS scores for the current pain and pain during exercise. WOMAC scores were also lower in the FPC group at week 4 (12.50 [8.00-22.50] vs . 16.00 [11.00-27.00], P = 0.010), mainly driven by the dimension of daily activity difficulty. In addition, the FPC group experienced a significantly lower incidence of adverse events (5.6% [7/124] vs . 33.6% [42/125], P <0.001), including irritation, rash and pain of the skin, and sticky hair uncovering pain. CONCLUSIONS This study suggested that FPC is superior to LSC for treating patients with knee OA in pain relief, joint function improvement, and safety profile.
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Affiliation(s)
- Dong Li
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Ping Yuan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Ziyang Wu
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Jiabang Liu
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Jinfu Kan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Kun Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Zhanguo Wang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Hui Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Guangwu Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Tao Xue
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Junxiu Jia
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Zhenpeng Guan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
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Wijnen A, Seeber GH, Dietz G, Dijkstra B, Dekker JS, Vermeulen KM, Slager GEC, Hessel A, Lazovic D, Bulstra SK, Stevens M. Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany. BMC Musculoskelet Disord 2023; 24:525. [PMID: 37370054 DOI: 10.1186/s12891-023-06654-w] [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] [Received: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. METHODS A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. RESULTS 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. CONCLUSIONS German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. TRIAL REGISTRATION The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).
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Affiliation(s)
- Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Gesine H Seeber
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Günter Dietz
- Clinic for Orthopedic and Rheumatological Rehabilitation, Reha-Zentrum Am Meer Bad Zwischenahn, Bad Zwischenahn, Germany
- Praxis Für Orthopädie, Bad Zwischenahn, Germany
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johan S Dekker
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geranda E C Slager
- Department of Physical Therapy, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aike Hessel
- Deutsche Rentenversicherung Oldenburg, Bremen, Germany
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Struik T, Mastbergen SC, Brouwer RW, Custers RJH, van Geenen RCI, Heusdens CHW, Emans PJ, Huizinga MR, Jansen MP. Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up. RMD Open 2023; 9:rmdopen-2023-003074. [PMID: 37290929 DOI: 10.1136/rmdopen-2023-003074] [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: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Knee distraction treatment for end-stage osteoarthritis successfully postpones arthroplasty for years. Studies performed thus far used general intended use, patient-personalised or custom-made devices. In this study, for the first time, a device specifically designed for knee distraction is evaluated. DESIGN 65 patients (≤65 years) with end-stage knee osteoarthritis indicated for arthroplasty received knee distraction. Before, 1-year and 2-year post-treatment, questionnaires were filled out and knee radiographs made. Adverse events and self-reported pain medication were registered. RESULTS Forty-nine patients completed 2-year follow-up: one patient did not complete treatment, three patients received arthroplasty in the first and four patients in the second year follow-up. Eight patients were lost to follow-up in the second year. The total Western Ontario and McMaster Universities Osteoarthritis Index score showed a clinically relevant improvement at 1 and 2 years (+26 and +24 points), as did all subscales (all p<0.001). The minimum radiographic joint space width improved over 1 (+0.5 mm; p<0.001) and 2 (+0.4 mm; p=0.015) years, as did the physical Short-Form 36 (+10 points; p<0.001). The most common adverse event was pin tract infection, experienced by 66% of patients, in 88% successfully treated with oral antibiotics. In two cases, hospitalisation and/or intravenous antibiotics were needed. Eight patients experienced device-related complications. None of the complications influenced 2-year outcomes. Before treatment, 42% of patients used pain medication, which had nearly been halved 1 (23%; p=0.02) and 2 years (29%; p=0.27) post-treatment. CONCLUSIONS Patients treated with a general applicable, for knee distraction purpose-built device showed, despite adverse events, significant clinical and structural improvement over 2 years. TRIAL REGISTRATION NUMBER NL7986.
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Affiliation(s)
- Thijmen Struik
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedics, Martini Hospital, Groningen, The Netherlands
| | - Roel J H Custers
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Christiaan H W Heusdens
- Department of Orthopedics, University Hospital Antwerp, Edegem, Antwerp, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Pieter J Emans
- Department of Orthopedics, Joint-Preserving Clinic, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Mooiweer Y, Seeber GH, Brütt AL, Eleveld R, Ulitzka R, Lazovic D, Ansmann L, Stevens M. Influence of health system and patient characteristics on expectations and outcome in total hip arthroplasty patients in the Dutch-German border region: protocol for a mixed-methods prospective observational comparative study (hip across). BMJ Open 2023; 13:e067499. [PMID: 37105704 PMCID: PMC10151850 DOI: 10.1136/bmjopen-2022-067499] [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: 04/29/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the treatment of choice for end-stage osteoarthritis of the hip. Management of THA differs between countries, and it is hypothesised that this can influence patients' expectations and self-efficacy. Using Chen's intervening mechanism evaluation approach, this study aims to explore how structure of care influences expectations and self-efficacy of patients undergoing THA, and how expectations and self-efficacy in turn influence outcome in terms of perceived physical function and satisfaction. METHODS AND ANALYSIS A mixed-methods study will be conducted in two German and two Dutch hospitals near the Dutch-German border. In the quantitative part, patients will complete questionnaires at three timepoints: preoperatively and at 3 and 6 months postoperatively. Data analysis will include multiple regression analysis and structural equation modelling. In the qualitative part, interviews will be held with patients (preoperatively and 3 months postoperatively) and healthcare providers. Analysis will be performed using structured qualitative content analysis. ETHICS AND DISSEMINATION The study is approved by the Institutional Review Boards of both Carl von Ossietzky University Oldenburg (2021-167) and University Medical Center Groningen (METc 2021/562 and METc 2021/601). The results will be disseminated in the international scientific community via publications and conference presentations. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Registry (DRKS: DRKS00026744).
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Affiliation(s)
- Yvet Mooiweer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Rienk Eleveld
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Raimund Ulitzka
- Department of Orthopedics and Trauma Surgery, Klinikum Leer gGmbH, Leer, Germany
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
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Aoyagi K, Law LF, Carlesso L, Nevitt M, Lewis CE, Wang N, Neogi T. Post-surgical contributors to persistent knee pain following knee replacement: The Multicenter Osteoarthritis Study (MOST). OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100335. [PMID: 36798734 PMCID: PMC9926203 DOI: 10.1016/j.ocarto.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Objective Pain persistence following knee replacement (KR) occurs in ∼20-30% of patients. Although several studies have identified preoperative risk factors for persistent post-KR pain, few have focused on post-KR contributing factors. We sought to determine whether altered nociceptive signaling and other peripheral nociceptive drivers present post-operatively contribute to post-KR pain. Design We included participants from the Multicenter Osteoarthritis Study who were evaluated ∼12 months after KR. We evaluated the relation of measures of pain sensitivity [pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM)] and the number of painful body sites to post-KR WOMAC knee pain, and of the number of painful sites to altered nociceptive signaling using linear or logistic regression models, as appropriate. Results 171 participants (mean age 69 years, 62% female) were included. TS was associated with worse WOMAC pain post-KR (β = 0.77 95% CI:0.19-1.35) and reduced odds of achieving patient acceptable symptom state (aOR = 0.54 95%CI:0.34-0.88). Inefficient CPM was also associated with worse WOMAC pain post-KR (β = 1.43 95% CI:0.15-2.71). In contrast, PPT was not associated with these outcomes. The number of painful body sites present post-KR was associated with TS (β = 0.05, 95% CI:0.01, 0.05). Conclusions Post-KR presence of central sensitization and inefficient descending pain modulation was associated with post-KR pain. We also noted that presence of other painful body sites contributes to altered nociceptive signaling, and this may thus also contribute to the experience of knee pain post-KR. Our findings provide novel insights into central pain mechanisms and other peripheral pain sources contributing to post-KR persistent knee pain.
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Affiliation(s)
- Kosaku Aoyagi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, USA
| | | | | | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | | | - Na Wang
- Boston University School of Public Health, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
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11
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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: 0] [Impact Index Per Article: 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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12
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Georgopoulos V, Smith S, McWilliams DF, Steultjens MPM, Williams A, Price A, Valdes AM, Vincent TL, Watt FE, Walsh DA. Harmonising knee pain patient-reported outcomes: a systematic literature review and meta-analysis of Patient Acceptable Symptom State (PASS) and individual participant data (IPD). Osteoarthritis Cartilage 2023; 31:83-95. [PMID: 36089231 DOI: 10.1016/j.joca.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In order to facilitate data pooling between studies, we explored harmonisation of patient-reported outcome measures (PROMs) in people with knee pain due to osteoarthritis or knee trauma, using the Patient Acceptable Symptom State scores (PASS) as a criterion. METHODS We undertook a systematic literature review (SLR) of PASS scores, and performed individual participant data (IPD) analysis of score distributions from concurrently completed PROM pairs. Numerical rating scales (NRS), visual analogue scales, KOOS and WOMAC pain questionnaires were standardised to 0 to 100 (worst) scales. Meta-regression explored associations of PASS. Bland Altman plots compared PROM scores within individuals using IPD from WebEx, KICK, MenTOR and NEKO studies. RESULTS SLR identified 18 studies reporting PASS in people with knee pain. Pooled standardised PASS was 27 (95% CI: 21 to 35; n = 6,339). PASS was statistically similar for each standardised PROM. Lower PASS was associated with lower baseline pain (β = 0.49, P = 0.01) and longer time from treatment initiation (Q = 6.35, P = 0.04). PASS scores were lowest in ligament rupture (12, 95% CI: 11 to 13), but similar between knee osteoarthritis (31, 95% CI: 26 to 36) and meniscal tear (27, 95% CI: 20 to 35). In IPD, standardised PROMs each revealed similar group mean scores, but scores within individuals diverged between PROMs (LoA between -7 to -38 and +25 to 52). CONCLUSION Different standardised PROMs give similar PASS thresholds in group data. PASS thresholds may be affected more by patient and treatment characteristics than between PROMs. However, different PROMs give divergent scores within individuals, possibly reflecting different experiences of pain.
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Affiliation(s)
- V Georgopoulos
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - S Smith
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - D F McWilliams
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - M P M Steultjens
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, UK.
| | - A Williams
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Fortius Clinic, London, UK.
| | - A Price
- Department of Immunology and Inflammation, Imperial College London, UK; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - A M Valdes
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
| | - T L Vincent
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - F E Watt
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, UK; Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK.
| | - D A Walsh
- Academic Rheumatology, Pain Centre Versus Arthritis and NIHR Nottingham BRC, School of Medicine, University of Nottingham, UK.
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Patient-reported impairment following TKA is reduced when a computationally simulated predicted ideal alignment is achieved. Knee Surg Sports Traumatol Arthrosc 2023; 31:1098-1105. [PMID: 36446908 PMCID: PMC9957835 DOI: 10.1007/s00167-022-07225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome. This study aims to validate one such previously developed algorithm based on a simulated deep knee bend (the Dynamic Knee Score, DKS). METHODS 1074 TKA patients with pre- and post-operative Computerised Tomography (CT) scans and 12-month post-operative Knee Injury and Osteoarthritis Outcomes (KOOS) Scores were identified from the 360 Med Care Joint Registry. Landmarking and registration of implant position was performed on all CT scans, and each of the achieved TKAs was computationally simulated and received a predictive outcome score from the DKS. In addition, a set of potential alternative surgical plans which might have been followed were simulated. Comparison of patient-reported issues and DKS score was evaluated in a counter-factual study design. RESULTS Patient-reported impairment with the knee catching and squatting was shown to be 30% lower (p = 0.005) and 22% lower (p = 0.026) in patients where the best possible DKS result was the one surgically achieved. Similar findings were found relating attainment of the best tibial slope and posterior femoral resection DKS plans to patient-reported difficulty straightening the knee (40% less likely, p < 0.001) and descending stairs (35% less likely, p = 0.006). CONCLUSION The DKS has been shown to correlate with presence of patient-reported impairments post-TKA and the resultant algorithm can be applied in a pre-operative planning setting. Outcome optimization in the future may come from patient-specific selection of an alignment strategy and simulations may be a technological enabler of this trend. LEVEL OF EVIDENCE III (Retrospective Cohort Study).
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Outcomes Vary Significantly Using a Tiered Approach to Define Success After Total Knee Arthroplasty. J Arthroplasty 2022; 37:1266-1272. [PMID: 35202758 DOI: 10.1016/j.arth.2022.02.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROM) allow assessment of clinical outcomes following primary total knee arthroplasty (TKA). The purpose of this study is to use progressively more stringent definitions of success to examine clinical outcomes of primary TKA at 1 year postoperatively and to determine which demographic variables were associated with achieving clinical success. METHODS The American Joint Replacement Registry was queried from 2012 to 2020 for primary TKA. Patients who completed the following PROMs preoperatively and 1 year postoperatively were included: Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and KOOS for Joint Replacement (KOOS JR). Mean PROM scores were determined for each visit and between-visit changes were evaluated using paired t-tests. Rates of achievement of minimal clinically important difference (MCID) by distribution-based and anchor-based criteria, Patient Acceptable Symptom State, and substantial clinical benefit were calculated. Logistic regression was used to evaluate the association between demographic variables and odds of clinical success. RESULTS In total, 12,341 TKAs were included. Mean improvement in PROM scores were as follows: KOOS JR, 29; WOMAC-Pain, 33; and WOMAC-Function, 31 (P < .0001 for all). Rates of achievement of each metric were the following: distribution-based MCID, 84%-87%; anchor-based MCID, 46%-79%; Patient Acceptable Symptom State, 54%-82%; and substantial clinical benefit, 68%-81%. Patient age and gender were the most influential demographic factors on achievement of clinical success. CONCLUSION Clinical outcomes at 1 year following TKA vary significantly when using a tiered approach to define success. A tiered approach to interpretation of PROMs should be considered for future research and clinical assessment.
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Defining Clinically Meaningful Thresholds for Patient-Reported Outcomes in Knee Arthroplasty. J Arthroplasty 2022; 37:837-844.e3. [PMID: 35134515 DOI: 10.1016/j.arth.2022.01.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For primary knee arthroplasties, clinically meaningful thresholds of patient-reported outcomes that associate with patient satisfaction have not been defined appropriately. METHODS In this retrospective study of 26,720 primary total knee replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes (MCICs) and patient acceptable symptom states (PASSs) with the anchor satisfaction. Patient-reported outcome measures were pain, European Quality of Life 5 Dimensions, Knee disability and Osteoarthritis Outcome Score, and Oxford Knee Score (OKS). Independent analyses were performed for groups, which showed statistically significant interactions with the (change in) score to achieve satisfaction in logistic regression. RESULTS In this cohort, 84.9% completed the anchor questions, of whom 71.3% with a satisfaction score ≥8. Good discriminative abilities (area under the receiving operator curve >0.8) for PASS were achieved by OKS ≥38.5, pain in activity ≤2.5, Knee disability and Osteoarthritis Outcome Score ≤33, and Quality of Life-Index ≥0.813. Discriminative abilities for MCIC were not good. If assessed per baseline tercile, discrimination improved (area under the receiving operator curve >0.8) and yielded different MCICs per preoperative tercile (preoperative OKS ≤19: MCIC ≥19.5; pre-OKS 20-27: MCIC ≥14.5; pre-OKS ≥28: MCIC ≥8.5). For MCIC, the tercile method produced an 11% improved accuracy compared to one threshold for every patient. For the PASS scores, tercile-specific did not improve the accuracy of predicting satisfaction. Demographics were not clinically relevant in determining thresholds. CONCLUSION Estimating the likelihood of satisfaction with surgery is critical in shared decision-making. Patients with more preoperative symptom severity require larger changes to report satisfaction. Both in the clinic and in science, such differences must be considered when predictions of satisfaction are attempted.
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Miralles-Muñoz FA, Gonzalez-Parreño S, Martinez-Mendez D, Gonzalez-Navarro B, Ruiz-Lozano M, Lizaur-Utrilla A, Alonso-Montero C. A validated outcome categorization of the knee society score for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:1266-1272. [PMID: 33839804 DOI: 10.1007/s00167-021-06563-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine cutoff values for the Knee Society Scores (KSS) indicative of a categorical scale of medium-term outcomes. METHODS One hundred and fifty-five patients who underwent primary cruciate-retaining TKA with a patellar button for osteoarthritis at a single-centre were assessed prospectively by the KSS and short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) simultaneously at the 3-year follow-up. A validated categorization of the WOMAC score was used as a standard. The area under the curve (AUC) of receiver-operating characteristic (ROC) was used to assess the discriminative analysis accuracy of the, and the Youden index estimated the optimal cutoff point. RESULTS For the KSS-knee score, the cutoff for an excellent outcome was 90.3 (AUC 0.75, 95% CI 0.71-0.78), 76.6 (AUC 76.6, 95% CI 0.70-076) for good, 64.8 (AUC 0.76, 95% CI 0.72-0.79) for fair, and < 64.8 (AUC 0.69, 95% CI 0.67-0.73) for poor. For the KSS-function score, the cutoff values were 85.2 (AUC 0.71, 95% CI 0.69-0.75), 73.1 (AUC 0.72, 95% CI, 0.70-0.76), 55.7 (AUC 0.70, 95% CI 0.71-0.74), and < 55.7 (AUC 0.68, 95% CI 0.66-0.72), respectively. CONCLUSION A KSS-knee score ≥ of 90 was considered an excellent outcome, 77 good, 65 fair, and < 65 poor. For the KSS-function, those values are 85, 73, 56 and < 56, respectively. The treatment outcome's judgement may be clearer for the surgeon concerning a particular patient when using cutoff values for the scoring system employed, such as those determined in the present study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Daniel Martinez-Mendez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain.
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, N-332 km 87 s/n, 03550, San Juan de Alicante, Alicante, Spain.
| | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, N-332 km 87 s/n, 03550, San Juan de Alicante, Alicante, Spain
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Dowsey MM, Spelman T, Choong PFM. A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement. J Clin Med 2022; 11:jcm11061649. [PMID: 35329975 PMCID: PMC8955143 DOI: 10.3390/jcm11061649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Total hip replacement (THR) is a common and cost-effective procedure for end-stage osteoarthritis, but inappropriate utilization may be devaluing its true impact. The purpose of this study was to develop and test the internal validity of a prognostic algorithm for predicting the probability of non-response to THR surgery at 1 year. Methods: Analysis of outcome data extracted from an institutional registry of individuals (N = 2177) following elective THR performed between January 2012 and December 2019. OMERACT-OARSI responder criteria were applied to Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scores at pre- and 1 year post-THR, to determine non-response to surgery. Independent prognostic correlates of post-operative non-response observed in adjusted modelling were then used to develop a nomogram. Results: A total of 194 (8.9%) cases were deemed non-responders to THR. The degree of contribution (OR, 95% CI) of each explanatory factor to non-response on the nomogram was, morbid obesity (1.88, 1.16, 3.05), Kellgren−Lawrence grade <4 (1.89, 1.39, 2.56), WOMAC Global rating per 10 units (0.86, 0.79, 0.94) and the following co-morbidities: cerebrovascular disease (2.39, 1.33, 4.30), chronic pulmonary disease (1.64; 1.00, 2.71), connective tissue disease (1.99, 1.17, 3.39), diabetes (1.86, 1.26, 2.75) and liver disease (2.28, 0.99, 5.27). The concordance index for the nomogram was 0.70. Conclusion: We have developed a prognostic nomogram to calculate the probability of non-response to THR surgery. In doing so, we determined that both the probability of and predictive prognostic factors for non-response to THR differed from a previously developed nomogram for total knee replacement (TKR), confirming the benefit of designing decision support tools that are both condition and surgery site specific. Future external validation of the nomogram is required to confirm its generalisability.
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Affiliation(s)
- Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Correspondence: ; Tel.: +61-3-9288-3955; Fax: +61-3-9416-3610
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
| | - Peter F. M. Choong
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
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Twiggs J, Miles B, Roe J, Fritsch B, Liu D, Parker D, Dickison D, Shimmin A, BarBo J, McMahon S, Solomon M, Boyle R, Walter L. Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool. Knee 2021; 33:38-48. [PMID: 34543991 DOI: 10.1016/j.knee.2021.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer simulations of knee movement allow Total Knee Arthroplasty (TKA) dynamic outcomes to be studied. This study aims to build a model predicting patient reported outcome from a simulation of post-operative TKA joint dynamics. METHODS Landmark localisation was performed on 239 segmented pre-operative computerized tomography (CT) scans to capture patient specific soft tissue attachments. The pre-operative bones and 3D implant files were registered to post-operative CT scans following TKA. Each post-operative knee was simulated undergoing a deep knee bend with assumed ligament balancing of the extension space. The kinematic results from this simulation were used in a Multivariate Adaptive Regression Spline algorithm, predicting attainment of a Patient Acceptable Symptom State (PASS) score in captured 12 month post-operative Knee Injury and Osteoarthritis Outcome Scores (KOOS). An independent series of 250 patients was evaluated by the predictive model to assess how the predictive model behaved in a pre-operative planning context. RESULTS The generated predictive algorithm, called the Dynamic Knee Score (DKS) contained features, in order of significance, related to tibio-femoral force, patello-femoral motion and tibio-femoral motion. Area Under the Curve for predicting attainment of the PASS KOOS Score was 0.64. The predictive model produced a bimodal spread of predictions, reflecting a tendency to either strongly prefer one alignment plan over another or be ambivalent. CONCLUSION A predictive algorithm relating patient reported outcome to the outputs of a computational simulation of a deep knee bend has been derived (the DKS). Simulation outcomes related to tibio-femoral balance had the highest correlation with patient reported outcome.
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Affiliation(s)
| | | | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, North Sydney 2060, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Gold Coast 4221, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
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Comparison of Existing and New Total Knee Arthroplasty Implant Systems From the Same Manufacturer: A Prospective, Multicenter Study. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00010. [PMID: 34908561 PMCID: PMC8678005 DOI: 10.5435/jaaosglobal-d-21-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022]
Abstract
This study evaluated total knee arthroplasty (TKA) outcomes for an Existing-TKA versus New-TKA from the same manufacturer.
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Review of patient-reported outcomes in periprosthetic distal femur fractures after total knee arthroplasty: a plate or intramedullary nail? ARTHROPLASTY 2021; 3:24. [PMID: 35236480 PMCID: PMC8796545 DOI: 10.1186/s42836-021-00080-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/20/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty. Methods A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05. Results The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05). Conclusion Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.
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21
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Escobar A, Bilbao A, Bertrand ML, Moreta J, Froufe MA, Colomina J, Martınez-Cruz O, Perera RA, Riddle DL. Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study. J Orthop Surg Res 2021; 16:227. [PMID: 33781327 PMCID: PMC8006353 DOI: 10.1186/s13018-021-02371-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA). METHODS We applied the RAND/UCLA Appropriateness Method to derive our second-generation system and conducted a prospective study of patients diagnosed with knee osteoarthritis in eight public hospitals in Spain. Main outcome questionnaires were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form-12 (SF-12), and the Knee Society Score satisfaction scale (KSS), completed before and 6 months after TKA. Baseline, changes from baseline to 6 months (journey outcome), and 6-month scores (destination outcome) were compared according to appropriateness category. Percentage of patients attaining the minimal clinically important difference (MCID) and responders according to Outcome Measures in Rheumatology-Osteoarthritis Research Society (OMERACT-OARSI) criteria were also reported. RESULTS A total of 282 patients completed baseline and 6-month questionnaires. Of these, 142 (50.4%) were classified as Appropriate, 90 (31.9%) as Uncertain, and 50 (17.7%) as Inappropriate. Patients classified as Appropriate had worse preoperative pain, function, and satisfaction (p < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004). CONCLUSIONS The validity of our second-generation appropriateness system was generally supported. The findings highlight a critical issue in TKA healthcare: whether TKA appropriateness should be driven by the extent of improvement, by patient final state, or by both.
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Affiliation(s)
- Antonio Escobar
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain
- Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain.
- Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain.
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Maria L Bertrand
- Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain
- University of Malaga, Malaga, Spain
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, Marbella, Spain
| | - Jesús Moreta
- Biocruces-Bizkaia Health Research Institute, Group of Lower Limb Reconstructive Surgery, Barakaldo, Spain
- Osakidetza Basque Health Service, Department of Orthopaedic Surgery and Traumatology, Galdakao-Usansolo University Hospital, Galdakao, Spain
| | - Miquel A Froufe
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Jordi Colomina
- Department of Orthopaedic Surgery and Traumatology, Santa Maria University Hospital, Lleida, Spain
| | - Olga Martınez-Cruz
- Àmbit d'Avaluació, Agència de Qualitat i Avaluacio´ Sanitaries de Catalunya (AQuAS), Departament de Salut - Generalitat de Catalunya, Barcelona, Spain
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA, USA
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Leta TH, Gjertsen JE, Dale H, Hallan G, Lygre SHL, Fenstad AM, Dyrhovden GS, Westberg M, Wik TS, Jakobsen RB, Aamodt A, Röhrl SM, Gøthesen ØJ, Lindalen E, Heir S, Ludvigsen J, Bruun T, Hansen AK, Aune KEM, Warholm M, Skjetne JP, Badawy M, Høvding P, Husby OS, Karlsen ØE, Furnes O. Antibiotic-Loaded Bone Cement in Prevention of Periprosthetic Joint Infections in Primary Total Knee Arthroplasty: A Register-based Multicentre Randomised Controlled Non-inferiority Trial (ALBA trial). BMJ Open 2021; 11:e041096. [PMID: 33509845 PMCID: PMC7845702 DOI: 10.1136/bmjopen-2020-041096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The current evidence on the efficacy of antibiotic-loaded bone cement (ALBC) in reducing the risk of periprosthetic joint infections (PJI) after primary joint reconstruction is insufficient. In several European countries, the use of ALBC is routine practice unlike in the USA where ALBC use is not approved in low-risk patients. Therefore, we designed a double-blinded pragmatic multicentre register-based randomised controlled non-inferiority trial to investigate the effects of ALBC compared with plain bone cement in primary total knee arthroplasty (TKA). METHODS AND ANALYSIS A minimum of 9,172 patients undergoing full-cemented primary TKA will be recruited and equally randomised into the ALBC group and the plain bone cement group. This trial will be conducted in Norwegian hospitals that routinely perform cemented primary TKA. The primary outcome will be risk of revision surgery due to PJI at 1-year of follow-up. Secondary outcomes will be: risk of revision due to any reason including aseptic loosening at 1, 6, 10 and 20 years of follow-up; patient-related outcome measures like function, pain, satisfaction and health-related quality of life at 1, 6 and 10 years of follow-up; risk of changes in the microbial pattern and resistance profiles of organisms cultured in subsequent revisions at 1, 6, 10 and 20 years of follow-up; cost-effectiveness of routine ALBC versus plain bone cement use in primary TKA. We will use 1:1 randomisation with random permuted blocks and stratify by participating hospitals to randomise patients to receive ALBC or plain bone cement. Inclusion, randomisation and follow-up will be through the Norwegian Arthroplasty Register. ETHICS AND DISSEMINATION The trial was approved by the Western Norway Regional Committees on Medical and Health Research Ethics (reference number: 2019/751/REK vest) on 21 June 2019. The findings of this trial will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04135170.
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Affiliation(s)
- Tesfaye H Leta
- Faculty of Health Science, VID Specialized University, Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Håkon Låstad Lygre
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Gro Sævik Dyrhovden
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marianne Westberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tina Stromdal Wik
- Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, The Norwegian University of Science and Technology, Bergen, Norway
| | - Rune Bruhn Jakobsen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus Universitetssykehus HF, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diakonal Hospital, Oslo, Norway
| | | | - Øystein Johannes Gøthesen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Orthopaedic, Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Einar Lindalen
- Department of Orthopaedic Surgery, Lovisenberg Diakonal Hospital, Oslo, Norway
| | - Stig Heir
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway
| | - Jarle Ludvigsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Trond Bruun
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ann Kristin Hansen
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | | | - Marianne Warholm
- Department of Information and Communication Technology, Western Norway Regional Health Authority, Bergen, Norway
| | - John Petter Skjetne
- Department of Information and Technology, Central Norway Regional Health Authority, Trondheim, Norway
| | - Mona Badawy
- Coastal Hospital in Hagavik, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Pål Høvding
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Thuraisingam S, Dowsey M, Manski-Nankervis JA, Spelman T, Choong P, Gunn J, Chondros P. Developing prediction models for total knee replacement surgery in patients with osteoarthritis: Statistical analysis plan. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100126. [DOI: 10.1016/j.ocarto.2020.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
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Pollmann CT, Gjertsen JE, Dale H, Straume-Næsheim TM, Dybvik E, Hallan G. Operative approach influences functional outcome after DAIR for infected total hip arthroplasty. Bone Joint J 2020; 102-B:1662-1669. [DOI: 10.1302/0301-620x.102b12.bjj-2020-0501.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims To compare the functional outcome, health-related quality of life (HRQoL), and satisfaction of patients who underwent primary total hip arthroplasty (THA) and a single debridement, antibiotics and implant retention (DAIR) procedure for deep infection, using either the transgluteal or the posterior surgical approach for both procedures. Methods The study was registered at clinicaltrials.gov (ID: NCT03161990) on 15 May 2017. Patients treated with a single DAIR procedure for deep infection through the same operative approach as their primary THA (either the transgluteal or the posterior approach) were identified in the Norwegian Arthroplasty Register and given a questionnaire. Median follow-up after DAIR by questionnaire was 5.5 years in the transgluteal group (n = 87) and 2.5 years in the posterior approach group (n = 102). Results Patients in the posterior approach group were less likely to limp after the DAIR procedure (17% vs 36% limped all the time; p = 0.005), had a higher mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (80 vs 71; p = 0.013), and were more likely to achieve a patient acceptable symptom state for the WOMAC function score (76% vs 55%; p = 0.002). In a multivariable analysis, the point estimate for the increase in WOMAC function score using the posterior approach was 10.2 (95% CI 3.1 to 17.2; p = 0.005), which is above the minimal clinically important improvement. The patients in the posterior approach group also reported better mean HRQoL scores and were more likely to be satisfied with their hip arthroplasty (77% vs 55%; p = 0.001). Conclusion In patients treated with a single, successful DAIR procedure for deep infection of a primary THA, the use of the posterior approach in both primary surgery and DAIR was associated with less limping, better functional outcome, better HRQoL, and higher patient satisfaction compared with cases where both were performed using the transgluteal approach. The observed differences in functional outcome and patient satisfaction were clinically relevant. Cite this article: Bone Joint J 2020;102-B(12):1662–1669.
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Affiliation(s)
- Christian T. Pollmann
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Jan-Erik Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Håvard Dale
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Truls M. Straume-Næsheim
- Department of Orthopaedic Surgery, Haugesund Sanitetsforenings Rheumatism Hospital, Haugesund, Norway
| | - Eva Dybvik
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Wang Z, Deng W, Shao H, Zhou Y, Li H. Forgotten Joint Score Thresholds for Forgotten Joint Status and Patient Satisfaction after Unicompartmental Knee Arthroplasty in Chinese Patients. J Arthroplasty 2020; 35:2825-2829. [PMID: 32482475 DOI: 10.1016/j.arth.2020.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/19/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) and "forgotten joint" represent 2 treatment goals that arthroplasty surgeons often pursue. However, the actual Forgotten Joint Score (FJS-12) that corresponds to the PASS and forgotten joint in unicompartmental knee arthroplasty (UKA) patients remains unknown. METHODS One hundred ninety-three patients who underwent a medial UKA for knee osteoarthritis with a minimum of 1-year follow-up were included. Patients were asked to complete the FJS-12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. We used patient-reported satisfaction and the Patient's Joint Perception questions as anchors to determine the achievement of PASS and the forgotten joint, respectively. FJS-12 thresholds for PASS and the forgotten joint were calculated using the anchor-based receiver operating characteristic curve analysis. The ability of the FJS-12 and WOMAC scores to detect the PASS and forgotten joint was compared with DeLong's test. RESULTS Based on the answers to the anchor questions, 176 (91.2%) of the 193 total patients achieved the PASS and 34 (17.6%) patients achieved a forgotten joint after UKA. The FJS-12 outperformed the WOMAC with respect to detecting a forgotten joint (P = .008), but they performed equally well in terms of detecting PASS (P = .950). The FJS-12 threshold for PASS was 40.63 (sensitivity: 84.1%, specificity: 76.5%) and for the forgotten joint was 84.38 (sensitivity: 97.1%, specificity: 88.1%). CONCLUSION For UKA patients, the FJS-12 score has a superior ability to detect a forgotten joint when compared to the WOMAC. The FJS-12 threshold for the PASS is 40.63, while a score above 84.38 can be interpreted as having achieved a forgotten joint.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hua Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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Lamo-Espinosa JM, Blanco JF, Sánchez M, Moreno V, Granero-Moltó F, Sánchez-Guijo F, Crespo-Cullel Í, Mora G, San Vicente DD, Pompei-Fernández O, Aquerreta JD, Núñez-Córdoba JM, Vitoria Sola M, Valentí-Azcárate A, Andreu EJ, Del Consuelo Del Cañizo M, Valentí-Nin JR, Prósper F. Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis. J Transl Med 2020; 18:356. [PMID: 32948200 PMCID: PMC7501623 DOI: 10.1186/s12967-020-02530-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background Mesenchymal stromal cells are a safe and promising option to treat knee osteoarthritis as previously demonstrated in different clinical trials. However, their efficacy, optimal dose and addition of adjuvants must be determined. Here, we evaluated the clinical effects of a dose of 100 × 106 bone marrow mesenchymal stromal cells (BM-MSCs) in combination with Platelet Rich Plasma (PRGF®) as adjuvant in a randomized clinical trial. Methods A phase II, multicenter, randomized clinical trial with active control was conducted. Sixty patients diagnosed with knee OA were randomly assigned to 3 weekly doses of PRGF® or intraarticular administration of 100 × 106 cultured autologous BM-MSCs plus PRGF®. Patients were followed up for 12 months, and pain and function were assessed using VAS and WOMAC and by measuring the knee range of motion range. X-ray and magnetic resonance imaging analyses were performed to analyze joint damage. Results No adverse effects were reported after BM-MSC administration or during follow-up. According to VAS, the mean value (SD) for PRGF® and BM-MSC with PRGF® went from 5 (1.8) to 4.5 (2.2) (p = 0.389) and from 5.3 (1.9) to 3.5 (2.5) (p = 0.01), respectively at 12 months. In WOMAC, the mean (SD) baseline and 12-month overall WOMAC scores in patients treated with PRGF® was 31.9 (16.2) and 22.3 (15.8) respectively (p = 0.002) while that for patients treated with BM-MSC plus PRGF® was 33.4 (18.7) and 23.0 (16.6) (p = 0.053). Although statistical significances between groups have been not detected, only patients being treated with BM-MSC plus PRGF® could be considered as a OA treatment responders following OARSI criteria. X-ray and MRI (WORMS protocol) revealed no changes in knee joint space width or joint damage. Conclusions Treatment with BM-MSC associated with PRGF® was shown to be a viable therapeutic option for osteoarthritis of the knee, with clinical improvement at the end of follow-up. Further phase III clinical trials would be necessary to confirm the efficacy. Trial registration Clinical Trials.gov identifier NCT02365142. Nº EudraCT: 2011-006036-23
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Affiliation(s)
- José María Lamo-Espinosa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain. .,Cell Therapy Area, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain.
| | - Juan F Blanco
- Department of Orthopaedic Surgery and Traumatology, Complejo Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain.,Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Victoria Moreno
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | - Froilán Granero-Moltó
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain.,Cell Therapy Area, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | - Fermín Sánchez-Guijo
- Department of Haematology, Complejo Hospitalario de Salamanca-IBSAL, Salamanca, Spain
| | - Íñigo Crespo-Cullel
- Department of Orthopaedic Surgery and Traumatology, Complejo Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Gonzalo Mora
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | | | | | | | - Jorge María Núñez-Córdoba
- Division of Biostatistics, Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain
| | - María Vitoria Sola
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | - Andrés Valentí-Azcárate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | - Enrique J Andreu
- Cell Therapy Area, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | | | - Juan Ramón Valentí-Nin
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain
| | - Felipe Prósper
- Cell Therapy Area, Clínica Universidad de Navarra, 36 Pío XII Avenue, 31008, Pamplona, Spain. .,Department of Haematology, Clínica Universidad de Navarra, Pamplona, Spain.
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Klem NR, Smith A, O'Sullivan P, Dowsey MM, Schütze R, Kent P, Choong PF, Bunzli S. What Influences Patient Satisfaction after TKA? A Qualitative Investigation. Clin Orthop Relat Res 2020; 478:1850-1866. [PMID: 32732567 PMCID: PMC7371044 DOI: 10.1097/corr.0000000000001284] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient satisfaction is a common measure of the success of an orthopaedic intervention. However, there is poor understanding of what satisfaction means to patients or what influences it. QUESTIONS/PURPOSES Using qualitative study methodology in patients undergoing TKA, we asked: (1) What does it mean to be satisfied after TKA? (2) What factors influence satisfaction levels after TKA? METHODS People in a hospital registry who had completed 12-month follow-up questionnaires and were not more than 18 months post-TKA at the time of sampling were eligible (n = 121). To recruit a sample that provided insight into a range of TKA experiences, we divided eligible candidates on the registry into quadrants based on their responder status and satisfaction level. A responder was an individual who experienced a clinically meaningful change in pain and/or function on the WOMAC according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Individuals were considered satisfied unless they indicated somewhat dissatisfied or very dissatisfied for one or more of the four items on the Self-Administered Patient Satisfaction Scale. From the resulting quadrants: responder satisfied, nonresponder satisfied, nonresponder dissatisfied, responder dissatisfied, we identified men and women with a range of ages and invited them to participate (n = 85). The final sample (n = 40), consisted of 10 responder satisfied, nine nonresponder satisfied, eight nonresponder dissatisfied, and 13 responder dissatisfied; 71% were women, with a mean age of 71 ± 7 years and a mean time since TKA surgery of 17 ± 2 months (range 13 to 25 months). Interview transcripts were analyzed by looking for factors in the participants' narrative that appeared to underscore their level of satisfaction and attaching inductive (data-derived, rather than a priori derived) codes to relevant sections of text. Coded data from participants who reported high and low levels of satisfaction were compared/contrasted and emerging patterns were mapped into a conceptual model. Recruitment continued until no new information was uncovered in data analysis of subsequent interviews, signalling to the researchers that further interviews would not change the key themes identified and data collection could cease. RESULTS In those with high satisfaction levels, satisfaction was conceptualized as an improvement in pain and function. In those with low satisfaction levels, rather than an improvement, satisfaction was conceptualized as completely resolving all symptoms and functional limitations. In addition, we identified three pathways through which participants reached different levels of low and high satisfaction: (1) The full-glass pathway, characterized by no or minimal ongoing symptoms and functional deficits, which consistently led to high levels of satisfaction; (2) the glass-half-full pathway, characterized by ongoing symptoms and functional limitations, which led to high satisfaction; and (3) the glass-half-empty pathway, also characterized by ongoing symptoms and functional limitations, which led to low satisfaction levels. The latter two pathways were mediated by three core mechanisms (recalibration, reframing valued activities, and reconceptualization) influenced either positively or negatively by (1) a persons' thoughts and feelings such as optimism, self-efficacy, pain catastrophizing, external locus of control; and (2) social and contextual factors such as fulfilment of social roles, therapeutic alliance, lack of family/social support. CONCLUSIONS This qualitative study suggests that for preoperative patients in whom unrealistically high hopes for complete symptom resolution and restoration of functional capacity persists, it may be appropriate to direct them away from TKA due to the risk of low satisfaction. For postoperative patients troubled by ongoing symptoms or functional limitations, clinicians may improve levels of satisfaction by targeting the three core mechanisms (recalibration, reframing valued activities, and reconceptualization) through addressing modifiable negative thoughts and feelings in interventions such as psychology or psychotherapy; and negative social and contextual factors by promoting a strong therapeutic alliance and engagement in community activities. Given that these factors may be identifiable preoperatively, future research is needed to explore if and how addressing them preoperatively may improve satisfaction post-TKA. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Nardia-Rose Klem
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Anne Smith
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Peter O'Sullivan
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Michelle M Dowsey
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Robert Schütze
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
| | - Peter Kent
- N.-R. Klem, A. Smith, P. O'Sullivan, R. Schütze, P. Kent, Curtin University, Bentley, Western Australia, Australia
- P. Kent, University of Southern Denmark, Odense, Denmark
| | - Peter F Choong
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Samantha Bunzli
- M. M. Dowsey, P. F. Choong, S. Bunzli, The University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
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Abstract
BACKGROUND When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender. QUESTIONS/PURPOSES (1) Does the association between widespread pain and no clinically important improvement in osteoarthritis-related pain and disability 2 years after TKA differ between men and women? (2) Does the use of pain medications 2 years after TKA differ between those with widespread pain and those without widespread pain before surgery? METHODS Osteoarthritis Initiative (https://nda.nih.gov/oai/) study participants were followed annually from March 2005 until October 2015. Participants who underwent TKA up to the 7-year follow-up visit with pain/disability assessment at the protocol-planned visit before TKA and at the second planned annual visit after surgery were included in the analysis. Among 4796 study participants, 391 had a confirmed TKA, including 315 with pain/disability assessment at the protocol-planned visit before TKA. Overall, 95% of participants (298) had the required follow-up assessment; 5% (17) did not have follow-up data. Widespread pain was defined based on the modified American College of Rheumatology criteria. Symptoms were assessed using the WOMAC pain (range 0 to 20; higher score, more pain) and disability (range 0 to 68; higher score, more disability) scores, and the Knee Injury and Osteoarthritis Outcome Score for pain (range 0 to 100; higher score, less pain). Improvements in pain and disability were classified based on improvement from established clinically important differences (decrease in WOMAC pain ≥ 1.5; decrease in WOMAC disability ≥ 6.0; increase in Knee Injury and Osteoarthritis Outcome Score for pain ≥ 9). At baseline, more women presented with widespread pain than men (45% [84 of 184] versus 32% [36 of 114]). Probability and the relative risk (RR) of no clinically important improvement were estimated using a logistic regression analysis in which participants with widespread pain and those without were compared. The analyses were done for men and women separately, then adjusted for depression and baseline outcome scores. RESULTS Among women, preoperative widespread pain was associated with an increased risk of no clinically important improvement 2 years after TKA, based on WOMAC pain scores (13.5% versus 4.6%; RR 2.93 [95% CI 1.18 to 7.30]; p = 0.02) and the Knee Injury and Osteoarthritis Outcome Score for pain (16.5% versus 4.9%; RR 3.39 [95% CI 1.34 to 8.59]; p = 0.02). Given the lower and upper limits of the confidence intervals, our data are compatible with a broad range of disparate associations between widespread pain and lack of clinically important improvement in WOMAC pain scores (RR 0.77 [95% CI 0.22 to 2.70]; p = 0.68) and the Knee Injury and Osteoarthritis Outcome Score for pain (RR 1.37 [95% CI 0.47 to 4.00]; p = 0.57) among men, as well as clinically important improvement in WOMAC disability scores among men (RR 0.72 [95% CI 0.20 to 2.55]; p = 0.61) and women (RR 1.98 [95% CI 0.92 to 4.26]; p = 0.08). Participants presenting with widespread pain before TKA were more likely than those without widespread pain to use medication for symptoms of knee osteoarthritis most days for at least 1 month 2 years after TKA (51% [61 of 120] versus 32% [57 of 178]; mean difference, 18.8 [95% CI 7.3 to 30.1]; p < 0.01). CONCLUSIONS Widespread pain before TKA was associated with an increased risk of no clinically important improvement in knee pain 2 years postoperatively among women. Because of the small number of men with widespread pain in the sample, the results for men were inconclusive. In clinical practice, screening TKA candidates for widespread pain may be useful, and expectations of surgical outcomes may need to be tempered if patients have a concurrent diagnosis of widespread pain. Future studies should include more men with widespread pain and investigate if treatment of widespread pain before or concurrent with TKA surgery may improve surgical outcomes. LEVEL OF EVIDENCE Level III, therapeutic study.
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Te Molder MEM, Smolders JMH, Heesterbeek PJC, van den Ende CHM. Definitions of poor outcome after total knee arthroplasty: an inventory review. BMC Musculoskelet Disord 2020; 21:378. [PMID: 32534571 PMCID: PMC7293790 DOI: 10.1186/s12891-020-03406-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/05/2020] [Indexed: 01/27/2023] Open
Abstract
Background A significant proportion of patients experiences poor response (i.e. no or little improvement) after total knee arthroplasty (TKA) because of osteoarthritis. It is difficult to quantify the proportion of patients who experiences poor response to TKA, as different definitions of, and perspectives (clinician’s and patient’s) on poor response are being used. The aim of this study was therefore to review the literature and summarize definitions of poor response to TKA. Methods A systematic search was performed to identify and review studies that included dichotomous definitions of poor outcome after primary TKA. The type, amount and combination of domains (e.g. functioning), outcome measures, type of thresholds (absolute/relative, change/cut-off), values and moments of follow-up used in definitions were summarized. Results A total of 47 different dichotomous definitions of poor response to TKA were extracted from 2163 initially identified studies. Thirty-six definitions incorporated one domain, seven definitions comprised two domains and four definitions comprised three domains. Eight different domains were used in identified definitions: pain, function, physical functioning, quality of life (QoL), patient satisfaction, anxiety, depression and patient global assessment. The absolute cut-off value was the most common type of threshold, with large variety in value and timing of follow-up. Conclusions Our inventory review shows that definitions of poor response to TKA are heterogeneous. Our findings stresses the need for an unambiguous definition of poor response to draw conclusions about the prevalence of poor-responders to TKA across hospitals and countries, and to identify patients at risk.
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Affiliation(s)
- Malou E M Te Molder
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands. .,Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - José M H Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Petra J C Heesterbeek
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Kwoh CK, Guehring H, Aydemir A, Hannon MJ, Eckstein F, Hochberg MC. Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints. Osteoarthritis Cartilage 2020; 28:782-791. [PMID: 32247871 DOI: 10.1016/j.joca.2020.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate associations between 2-year change in radiographic or quantitative magnetic resonance imaging (qMRI) structural measures, and knee replacement (KR), within a subsequent 7-year follow-up period. METHOD Participants from the Osteoarthritis Initiative were selected based on potential eligibility criteria for a disease-modifying osteoarthritis (OA) drug trial: Kellgren-Lawrence grade 2 or 3; medial minimum joint space width (mJSW) ≥2.5 mm; knee pain at worst 4-9 in the past 30 days on an 11-point scale, or 0-3 if medication was taken for joint pain; and availability of structural measures over 2 years. Mean 2-year change in structural measures was estimated and compared with two-sample independent t-tests for KR and no KR. Area under the receiver operating characteristic curve (AUC) was estimated using 2-year change in structural measures for prediction of future KR outcomes. RESULTS Among 627 participants, 107 knees underwent KR during a median follow-up of 6.7 years after the 2-year imaging period. Knees that received KR during follow-up had a greater mean loss of cartilage thickness in the total femorotibial joint and medial femorotibial compartment on qMRI, as well as decline in medial fixed joint space width on radiographs, compared with knees that did not receive KR. These imaging measures had similar, although modest discrimination for future KR (AUC 0.62, 0.60, and 0.61, respectively). CONCLUSIONS 2-year changes in qMRI femorotibial cartilage thickness and radiographic JSW measures had similar ability to discriminate future KR in participants with knee OA, suggesting that these measures are comparable biomarkers/surrogate endpoints of structural progression.
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Affiliation(s)
- C K Kwoh
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ, USA.
| | | | - A Aydemir
- EMD Serono Global Clinical Development Center, Billerica, MA, USA.
| | - M J Hannon
- University of Pittsburgh, Pittsburgh, PA, USA.
| | - F Eckstein
- Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - M C Hochberg
- University of Maryland School of Medicine, Baltimore, MD, USA.
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Dwyer T, Zochowski T, Ogilvie-Harris D, Theodoropoulos J, Whelan D, Chahal J. Determining the Patient Acceptable Symptomatic State for Patients Undergoing Arthroscopic Partial Meniscectomy in the Knee. Am J Sports Med 2020; 48:847-852. [PMID: 32167840 DOI: 10.1177/0363546520904017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy is one of the most common procedures in orthopaedic surgery. The patient acceptable symptomatic state (PASS), which defines a level of symptoms above which patients consider themselves well, remains to be well-defined in this population. PURPOSE Using an anchor-based approach, our goal was to determine the 1-year PASS for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Western Ontario Meniscal Evaluation Tool (WOMET), and the Marx Activity Scale (MAS) in patients who were treated with partial knee meniscectomy. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive series of patients with knee meniscal tears and a Kellgren-Lawrence grade of 0 to 2 treated with arthroscopic partial meniscectomy were eligible. The KOOS (0-100), IKDC (0-100), WOMET (0-100), and MAS (0-16) were administered at baseline and 12 months postoperatively. An external anchor question at 1 year postoperatively was used to determine PASS values. A receiver operating characteristic curve (ROC) analysis was used to determine the PASS value at which patients considered their status to be satisfactory. RESULTS The study included 110 patients (mean ± SD age, 53.8 ± 12.0 years), 57.3% were male, and the follow-up rate was 82%. In total, 70% of patients had an Outerbridge arthroscopic grade of 2 or lower. Based on ROC analysis, the 1-year postoperative PASS values (sensitivity, specificity) were 64.3 (47.8, 100.0) for KOOS Symptoms, 81.6 (71.6, 100.0) for KOOS Pain, 82.4 (82.1, 86.4) for KOOS Function in Daily Living, 71.0 (62.7, 81.8) for KOOS Function in Sport and Recreation, 51.0 (83.6, 95.5) for KOOS Knee-Related Quality of Life, 56.2 (82.1, 100.0) for IKDC, 58.5 (79.1, 100.0) for WOMET, and 7.0 (44.8, 68.2) for MAS. Baseline scores did not affect the PASS threshold across the different instruments. However, patients with higher baseline scores were more likely to achieve the PASS for the KOOS Symptoms (odds ratio [OR], 2.808; P = .047), IKDC (OR, 4.735; P = .006), and WOMET (OR, 2.985; P = .036). Age, sex, and cartilage status were not significantly related to the odds of achieving the PASS for any of the patient-reported outcome measures. CONCLUSION These findings allow researchers and clinicians to determine whether partial meniscectomy is meaningful to patients at the individual level and will be helpful for responder analysis in future trials related to the treatment of meniscal abnormality.
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Affiliation(s)
- Tim Dwyer
- Women's College Hospital, Toronto, Ontario, Canada.,Mt Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada
| | - Thomas Zochowski
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada.,Toronto Western Hospital, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Women's College Hospital, Toronto, Ontario, Canada.,Mt Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada
| | - Daniel Whelan
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- Women's College Hospital, Toronto, Ontario, Canada.,University of Toronto Orthopedic Sports Medicine, Toronto, Ontario, Canada.,Toronto Western Hospital, Toronto, Ontario, Canada
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Jansen MP, Mastbergen SC, van Heerwaarden RJ, Spruijt S, van Empelen MD, Kester EC, Lafeber FPJG, Custers RJH. Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data. PLoS One 2020; 15:e0227975. [PMID: 31968005 PMCID: PMC6975543 DOI: 10.1371/journal.pone.0227975] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. Methods In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. Results Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. Conclusions KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Department of Orthopedics, HagaZiekenhuis, Den Haag, The Netherlands
| | - Michelle D van Empelen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esmee C Kester
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J H Custers
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System Test for Patients Undergoing Knee Meniscal Surgery? Arthroscopy 2020; 36:241-250. [PMID: 31864584 DOI: 10.1016/j.arthro.2019.07.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/13/2019] [Accepted: 07/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds for the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) computerized adaptive test (CAT) instrument in patients undergoing arthroscopic meniscal surgery. METHODS The PROMIS PF CAT was administered preoperatively and postoperatively to patients undergoing arthroscopic meniscal surgery. At 6 months postoperatively, patients graded their knee function based on a domain-specific anchor question. A satisfaction anchor question was used to indicate achievement of the PASS. Receiver operating characteristic analysis determined the relevant psychometric values. Cutoff analysis was performed to find preoperative patient-reported outcome scores predicting achievement of clinically significant outcomes (CSOs). RESULTS A total of 73 patients (41.1% female patients) were included, with a mean age of 44.9 ± 12.8.0 years and average follow-up period of 24.0 ± 1.2 weeks. The MCID on the PROMIS PF CAT was calculated to be 2.09 (area under the curve [AUC], 0.75; 95% CI, 0.57-0.94). Net score improvement equivalent to achievement of SCB was found to be 6.50 (AUC, 0.77; 95% CI, 0.55-0.99). The PASS was found to be 46.1 (AUC, 0.86; 95% CI, 0.76-0.96). A preoperative score below 37.6 on the PROMIS PF CAT predicted achievement of the MCID (AUC, 0.76; 95% CI, 0.62-0.87), whereas scores above 41.9 predicted achievement of the PASS (AUC, 0.77; 95% CI, 0.65-0.90). Higher baseline functional status and the absence of pre-existing arthritis were also found to be statistically significant predictors of achieving CSOs. CONCLUSIONS Our study defined the MCID, SCB, and PASS for the PROMIS PF CAT. We found that a preoperative score below 37.6 was predictive of achieving a meaningful clinical change with surgery whereas a preoperative score above 41.9 was predictive of patients who would attain an acceptable postoperative health state. In addition, exercising more days per week and the absence of arthritis increased the likelihood of achieving postoperative CSOs. LEVEL OF EVIDENCE Level III, retrospective cohort.
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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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Investigating the patient acceptable symptom state cut-offs: longitudinal data from a community cohort using the shoulder pain and disability index. Rheumatol Int 2019; 40:599-605. [PMID: 31797040 DOI: 10.1007/s00296-019-04486-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
This prospective study aimed to determine the patient acceptable symptom state (PASS) cut-off for the patient reported outcome measure shoulder pain and disability index (SPADI), and evaluate predictors of PASS achievement following standard shoulder care. Patients with shoulder pain, referred for shoulder ultrasound were recruited from a community cohort. Patients completed both SPADI (scored 0-130) and a question on symptom state and followed-up at 6 months. PASS was calculated from Rasch-transformed scores using 2 methods: the 75th percentile of the cumulative response curve and the receiver operating characteristic curve (ROC). Logistic regression was used to identify factors associated with PASS. 304 participants (169 females, mean age 57.2 years) were included. At 6 months, 193 (63%) reported PASS. The association between SPADI at 6 months and PASS depended on baseline SPADI (interaction p = 0.036). Those with higher baseline scores had higher 6 months PASS cut-offs. Using the 75th percentile method, the 6 months total SPADI cut-off was 49.2 in those starting in the highest tertile at baseline compared to 39.4 in the lowest tertile: 46.4 vs. 36.7 for pain, 46.8 vs. 25.1 for disability. The ROC method yielded similar results. We have shown for the first time that the PASS cut-off for SPADI is dependent on baseline severity scores. Understanding the SPADI PASS threshold is important for clinical research to allow standardised reporting of shoulder intervention success at the patient level.
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Chang AH, Lee J, Song J, Price LL, Lee AC, Reid KF, Fielding RA, Driban JB, Harvey WC, Wang C. Association between Pre-Intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis - An Exploratory Study. ACR Open Rheumatol 2019; 1:104-112. [PMID: 31763622 PMCID: PMC6857980 DOI: 10.1002/acr2.1013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective Examine whether pre‐intervention physical activity (PA) level is associated with achieving a positive treatment response of pain and/or function improvement after a 12‐week exercise intervention in participants with knee osteoarthritis (OA). Methods We performed a secondary analysis of a randomized, single‐blind comparative effectiveness trial showing similar treatment effects between Tai Chi mind‐body exercise and standard physical therapy intervention for knee OA. Baseline PA was assessed by a Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and, in a subsample, by tri‐axial accelerometers. The Outcome Measures in Rheumatoid Arthritis Clinical Trials–Osteoarthritis Research Society International (OMERACT‐OARSI) dichotomous responder criteria was used for clinically meaningful improvement at follow‐up. Associations between baseline self‐reported PA by the CHAMPS questionnaire and outcomes of responders vs. nonresponders (reference group) were assessed using logistic regressions, adjusting for demographic covariates. We compared objectively measured PA by accelerometry between responders vs. nonresponders using Wilcoxon tests. Results Our sample consisted of 166 participants with knee OA who completed both baseline and 12‐week postintervention evaluations: mean age 60.7 year (SD 10.5), body mass index 32.4 kg/m2 (6.9), 119 (72%) women, and 138 (83%) OMERACT‐OARSI responders. Neither time spent in total PA [odds ratio (OR) 1.00; 95% confidence interval (CI) 0.96, 1.03] nor time in moderate‐to‐vigorous PA (OR 1.01; 95% CI 0.93, 1.09) at pre‐intervention were associated with being a responder. Similar findings were observed in 42 accelerometry sub‐cohort participants. Conclusion Pre‐intervention PA levels (subjective report or objective measurement) were not associated with individuals achieving favorable treatment outcomes after a 12‐week exercise intervention, which suggests that regardless of pre‐intervention PA level, individuals will likely benefit from structured exercise interventions.
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Affiliation(s)
- Alison H Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Rheumatology Division, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA and Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.,Center for Complementary and Integrative Medicine; Division of Rheumatology, Allergy & Immunology; Tufts Medical Center, Boston, MA, USA
| | - Augustine C Lee
- Center for Complementary and Integrative Medicine; Division of Rheumatology, Allergy & Immunology; Tufts Medical Center, Boston, MA, USA
| | - Kieran F Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA
| | - Jeffrey B Driban
- Center for Complementary and Integrative Medicine; Division of Rheumatology, Allergy & Immunology; Tufts Medical Center, Boston, MA, USA
| | - William C Harvey
- Center for Complementary and Integrative Medicine; Division of Rheumatology, Allergy & Immunology; Tufts Medical Center, Boston, MA, USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine; Division of Rheumatology, Allergy & Immunology; Tufts Medical Center, Boston, MA, USA
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Harrison-Brown M, Scholes C, Ebrahimi M, Field C, Cordingley R, Kerr D, Farah S, Kohan L. Predicting changes in the status of patient-reported outcome measures after Birmingham Hip Resurfacing: an observational cohort study with a median follow-up of ten years. Bone Joint J 2019; 101-B:1431-1437. [PMID: 31674251 DOI: 10.1302/0301-620x.101b11.bjj-2019-0663.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.
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Affiliation(s)
| | | | | | - C Field
- Joint Orthopaedic Centre, Sydney, Australia
| | | | - D Kerr
- Joint Orthopaedic Centre, Sydney, Australia
| | - S Farah
- Joint Orthopaedic Centre, Sydney, Australia.,AM Orthopaedics, Sydney, Australia
| | - L Kohan
- Joint Orthopaedic Centre, Sydney, Australia
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A systematic review of estimates of the minimal clinically important difference and patient acceptable symptom state of the Western Ontario and McMaster Universities Osteoarthritis Index in patients who underwent total hip and total knee replacement. Osteoarthritis Cartilage 2019; 27:1408-1419. [PMID: 31096046 DOI: 10.1016/j.joca.2019.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To systematically review the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) estimates in pain and function measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients who underwent primary total knee replacement (TKR) and primary total hip replacement (THR). DESIGN The study was carried out following PRISMA recommendations. We searched five electronic databases. Two reviewers independently screened titles, abstracts and full-text papers using a priori inclusion/exclusion criteria. Data were extracted by two independent reviewers. Data were synthesized, with WOMAC values converted to 0-100 scores (0 = best, 100 = worst). RESULTS Thirteen studies were included. Research methods used to calculate MCIDs and PASS varied across studies (e.g., using anchor-based or distribution methods, wording of anchor questions within anchor-based methods). Baseline WOMAC scores also varied across studies. Across studies and methods, MCIDs for the WOMAC in patients undergoing TKR ranged from 13.3 to 36.0 for pain and 1.8-33.0 for function; values for WOMAC in THR ranged from 8.3 to 41.0 for pain and from 9.7 to 34.0 for function. PASS cut-offs for TKR ranged from 25.0 to 28.6 for pain and 32.3-36.7 for function, and cut-offs for THR from 15.0 to 30.6 for pain and 28.0-42.0 for function. CONCLUSION Although the WOMAC is a commonly used measure for a single condition, the variability in methods used to calculate MCID and PASS estimates results in a range of values across studies making it unclear whether values reported in the literature can be applied with confidence. Future research is needed to refine methods used to calculate MCIDs and PASS.
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Chua JL, Goh GSH, Liow MHL, Tay DKJ, Lo NN, Yeo SJ. Modern TKA implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:1116-1123. [PMID: 30269170 DOI: 10.1007/s00167-018-5161-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/24/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare patient-reported outcomes measures, health-related quality of life and satisfaction rates between a new Modern TKA system (M-TKA) and an existing Traditional TKA system (T-TKA). METHODS Prospectively collected registry data of 65 patients who underwent T-TKA and 65 patients who underwent M-TKA at a single institution from 2014 to 2015 was reviewed. The range of motion, Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), SF-36, satisfaction and expectation fulfilment were compared at Pre-op, 6 months and 2 years. Patellofemoral joint-related OKS subscores (3, 5, 7, 12) were also compared between the groups. Minimal clinically important difference (MCID) in OKS/SF-36 were analysed for both groups. Propensity scores generated using logistic regression were used to adjust for confounding variables, thus allowing matching of T-TKA to M-TKA in a 1:1 ratio. RESULTS Both groups showed a significant improvement in all measured variables at 6 month and 2 years (p < 0.001) when compared to baseline. There was no significant difference in KSKS, KSFS, OKS, SF-36 and Patellofemoral joint-related OKS subscores (3, 5, 7, 12) between the two groups (n.s.). At 2 years, there were high satisfaction rates of 89.2% and 92.2% in the T-TKA and M-TKA groups, respectively (n.s.). Similarly, both groups demonstrated high expectation fulfilment rates of 84.6% and 90.6% for the T-TKA and M-TKA groups, respectively (n.s.). CONCLUSION Using an extensive battery of standardized patient-reported, health-related quality of life and MCID assessments, our study demonstrated no difference in clinical outcomes between M-TKA and T-TKA that would justify the use of the newer and costlier M-TKA. Longer follow-up is necessary to evaluate the possible advantages of this new implant design. LEVEL OF EVIDENCE Level III, Retrospective Study.
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Affiliation(s)
- Jia Long Chua
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment. PLoS One 2019; 14:e0214746. [PMID: 30934024 PMCID: PMC6443164 DOI: 10.1371/journal.pone.0214746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE 1) To systematically review the available scientific literature regarding specific instruments developed and/or tested in a Spanish population, to assess these PROMs in hip arthroplasty; 2) to carry out a standardized assessment of their measurement properties; and 3) to identify the best tools for use in Spain in an arthroplasty registry context. METHODS A systematic review of PubMed/MEDLINE and EMBASE and CINHAL was done. Furthermore, a standardized assessment of the questionnaires identified using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was performed. All developments, validation and studies aiming to assess the measurement properties of PROMs in hip arthroplasty in the Spanish population were included. Data from the questionnaires on metric properties was taken into account to identify the best candidates for inclusion in a register. RESULTS A total of 853 documents were found. After screening title and abstract, 13 full text documents were reviewed and 8 questionnaires adapted and validated to assess some of the aspects of hip arthroplasty in the Spanish population were identified. After the EMPRO assessment, 4 questionnaires showed suitable properties (WOMAC, OAKHQOL, mini-OAKHQOL and PFH). CONCLUSIONS In Spain, there are a few suitable hip-specific questionnaires currently available to assess PROMs in hip arthroplasty surgery. Some of the more widely used questionnaires, like the OHS and HOOS, have not been validated in the Spanish population until now. Identified tools are suitable for use in a clinical context, however their use in an arthroplasty register is more questionable due to the lack of validation studies of the widely used tools in other registers.
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Giesinger JM, Behrend H, Hamilton DF, Kuster MS, Giesinger K. Normative Values for the Forgotten Joint Score-12 for the US General Population. J Arthroplasty 2019; 34:650-655. [PMID: 30612834 DOI: 10.1016/j.arth.2018.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Forgotten Joint Score-12 (FJS-12) is a patient-reported outcome questionnaire of joint awareness in patients with hip and knee pathologies. To improve interpretability of values derived from this measure, we collected normative values for the US general population. METHODS A sample of 2000 participants, representative of US general population, was sought via an online panel. Quota sampling was used to obtain age-specific and sex-specific groups of 200 participants each. The FJS-12 is a 12-item questionnaire assessing the ability to forget the hip or knee joint during activities of daily living. To match US national census data from 2010, raking was used for determining data weights. RESULTS Normative data for the FJS-12 could be established based on a data set from 2017 respondents (50.1% men; mean age, 54.0 years; 66.3% white/Caucasian). Median FJS-12 scores in the total sample were 75.0 points for knees and 87.5 points for hips. In the age-specific and sex-specific groups, the lowest median score for knees was 54.2 points (men aged 18-39 years) and the highest median was 97.0 (men aged above 70 years). Similarly, median scores for hips were lowest in men aged 18-39 years (60.9 points) and highest in men aged above 70 years (100 points). CONCLUSION Normative values have been established for the FJS-12 for hips and knees in US general population. Age-specific and sex-specific differences require relying on normative values from the respective groups when interpreting FJS-12 data.
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Affiliation(s)
- Johannes M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - David F Hamilton
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Markus S Kuster
- Department of Orthopaedic Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Karlmeinrad Giesinger
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Harrison-Brown M, Scholes C, Hafsi K, Marenah M, Li J, Hassan F, Maffulli N, Murrell WD. Efficacy and safety of culture-expanded, mesenchymal stem/stromal cells for the treatment of knee osteoarthritis: a systematic review protocol. J Orthop Surg Res 2019; 14:34. [PMID: 30683159 PMCID: PMC6347797 DOI: 10.1186/s13018-019-1070-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Osteoarthritis is a progressive multifactorial condition of the musculoskeletal system with major symptoms including pain, loss of function, damage of articular cartilage and other tissues in the affected area. Knee osteoarthritis imposes major individual and social burden, especially with the cost and complexity of surgical interventions. Mesenchymal stem/stromal cells have been indicated as a treatment for degenerative musculoskeletal conditions given their capacity to differentiate into tissues of the musculoskeletal system. Methods A systematic search will be conducted in Medline, Embase, Cochrane Library, Scopus and relevant trial databases of English, Japanese, Korean, German, French, Italian, Spanish and Portuguese language papers published or in press to June 2018, with no restrictions on publication year applied. References will be screened and assessed for eligibility by two independent reviewers as per PRISMA guidelines. Cohort, cross-sectional or case controlled studies will be included for the analysis. Data extraction will be conducted using a predefined template and quality of evidence assessed. Statistical summaries and meta-analyses will be performed as necessary. Discussion Results will be published in relevant peer-reviewed scientific journals and presented at national or international conferences by the investigators. Trial registration The protocol was registered on the PROSPERO international prospective register of systematic reviews prior to commencement, CRD42018091763. Electronic supplementary material The online version of this article (10.1186/s13018-019-1070-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Kholoud Hafsi
- Emirates Integra Medical and Surgery Centre, Dubai, United Arab Emirates
| | - Maimuna Marenah
- Emirates Integra Medical and Surgery Centre, Dubai, United Arab Emirates
| | - Jinjie Li
- Emirates Integra Medical and Surgery Centre, Dubai, United Arab Emirates
| | - Fadi Hassan
- Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| | - William D Murrell
- Emirates Integra Medical and Surgery Centre, Dubai, United Arab Emirates.,Emirates Healthcare, Dubai, United Arab Emirates.,Department of Orthopaedic Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
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Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet 2018; 392:1672-1682. [PMID: 30496082 DOI: 10.1016/s0140-6736(18)32344-4] [Citation(s) in RCA: 358] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022]
Abstract
Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.
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Affiliation(s)
- Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jeffrey N Katz
- Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
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Hamilton DF, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AH, Howie CR, Giesinger JM. Treatment Success Following Joint Arthroplasty: Defining Thresholds for the Oxford Hip and Knee Scores. J Arthroplasty 2018; 33:2392-2397. [PMID: 29691169 DOI: 10.1016/j.arth.2018.03.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient-reported outcome scores are the mainstay method for quantifying success following arthroplasty. However, it is unclear when a "successful outcome" is achieved. We calculated threshold values for the Oxford Hip and Knee Score (OHS and OKS) representing achievement of a successful treatment at 12-month follow-up. METHODS Questionnaires were administered to patients undergoing total hip (THA) or knee (TKA) arthroplasty before and 12 months after surgery alongside questions assessing key aspects of treatment success. A composite success criterion was used to perform receiver operator characteristic analysis. Thresholds providing maximum sensitivity and specificity were determined for the total sample and subgroups defined by presurgery scores. RESULTS Data were available for 3203 THA and 2742 TKA patients. Applying the composite treatment success criterion, 67.3% of the TKA and 77.6% of the THA sample reported treatment success. Accuracy for predicting treatment success was high for the OHS and OKS (both areas under the curve, 0.87). For the OHS, a threshold value of 37.5 points showed highest sensitivity and specificity in the total sample, while for the OKS the optimal threshold was 32.5 points. Depending on presurgery scores, optimal thresholds varied between 32.5 and 38.5 for the OHS and 28.5 and 36.5 for the OKS. CONCLUSION This is the first study to apply a composite "success" anchor to the OHS and OKS to evaluate outcome following total joint arthroplasty. Notably fewer patients report a "successful outcome" using a composite outcome threshold than report being "satisfied."
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Affiliation(s)
- David F Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - Fanny L Loth
- University of Innsbruck, Faculty of Psychology and Sport Science, Innsbruck, Austria
| | - Deborah J MacDonald
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | | | - James T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - A Hamish Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin R Howie
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - Johannes M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
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Petursson G, Fenstad AM, Gøthesen Ø, Dyrhovden GS, Hallan G, Röhrl SM, Aamodt A, Furnes O. Computer-Assisted Compared with Conventional Total Knee Replacement: A Multicenter Parallel-Group Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1265-1274. [PMID: 30063588 DOI: 10.2106/jbjs.17.01338] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We previously reported the short-term radiographic and functional results of a randomized controlled trial (RCT) comparing computer-assisted and conventionally performed total knee replacement. We currently report the 2-year clinical results from this trial. METHODS One hundred and ninety patients were randomly allocated to undergo either computer-assisted or conventional total knee replacement. One hundred and seventy-two patients were available for clinical evaluation at 2 years, and 167 (97%) of those answered all patient-reported outcome measures (PROMs), including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), visual analog scale (VAS), and EuroQol-5 Dimensions (EQ-5D). Patients and clinical evaluators were blinded to the method of surgery. Surgical outcome was assessed using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) criteria to calculate responder rates, divided into high responders, moderate responders, and nonresponders. RESULTS The computer-assisted group had significantly more improvement than the conventional group in the mean scores for 2 subscales of the KOOS (7.4 for symptoms [p = 0.02] and 16.2 for sport and recreation [p < 0.01]) and in 1 subscale of the WOMAC (8.8 for stiffness [p = 0.03]).The computer-assisted group also had significantly more high responders (82.8%) than the conventional group (68.8%; p = 0.03) at 2 years, with the number needed to treat determined to be 8. CONCLUSIONS In this study, the use of computer navigation provided better pain relief and restored better function than the use of the conventional surgical technique at 2 years after total knee replacement. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gunnar Petursson
- Lovisenberg Diaconal Hospital, Oslo, Norway.,The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Øystein Gøthesen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Haugesund Sanitetsforenings Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Gro Sævik Dyrhovden
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stephan M Röhrl
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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46
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Lamo-Espinosa JM, Mora G, Blanco JF, Granero-Moltó F, Núñez-Córdoba JM, López-Elío S, Andreu E, Sánchez-Guijo F, Aquerreta JD, Bondía JM, Valentí-Azcárate A, Del Consuelo Del Cañizo M, Villarón EM, Valentí-Nin JR, Prósper F. Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II). J Transl Med 2018; 16:213. [PMID: 30064455 PMCID: PMC6069715 DOI: 10.1186/s12967-018-1591-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/25/2018] [Indexed: 01/08/2023] Open
Abstract
Background Mesenchymal stromal cells (MSCs) are a promising option to treat knee osteoarthritis (OA). Their safety and usefulness have been reported in several short-term clinical trials but less information is available on the long-term effects of MSC in patients with osteoarthritis. We have evaluated patients included in our previous randomized clinical trial (CMM-ART, NCT02123368) to determine their long-term clinical effect. Materials A phase I/II multicenter randomized clinical trial with active control was conducted between 2012 and 2014. Thirty patients diagnosed with knee OA were randomly assigned to Control group, intraarticularly administered hyaluronic acid alone, or to two treatment groups, hyaluronic acid together with 10 × 106 or 100 × 106 cultured autologous bone marrow-derived MSCs (BM-MSCs), and followed up for 12 months. After a follow up of 4 years adverse effects and clinical evolution, assessed using VAS and WOMAC scorings are reported. Results No adverse effects were reported after BM-MSCs administration or during the follow-up. BM-MSCs-administered patients improved according to VAS, median value (IQR) for Control, Low-dose and High-dose groups changed from 5 (3, 7), 7 (5, 8) and 6 (4, 8) to 7 (6, 7), 2 (2, 5) and 3 (3, 4), respectively at the end of follow up (Low-dose vs Control group, p = 0.01; High-dose vs Control group, p = 0.004). Patients receiving BM-MSCs also improved clinically according to WOMAC. Control group showed an increase median value of 4 points (− 11;10) while Low-dose and High-dose groups exhibited values of − 18 (− 28;− 9) and − 10 (− 21;− 3) points, respectively (Low-dose vs Control group p = 0.043). No clinical differences between the BM-MSCs receiving groups were found. Conclusions Single intraarticular injection of in vitro expanded autologous BM-MSCs is a safe and feasible procedure that results in long-term clinical and functional improvement of knee OA.
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Affiliation(s)
- José María Lamo-Espinosa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.,Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gonzalo Mora
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan F Blanco
- Department of Traumatology, Complejo Hospitalario de Salamanca, Salamanca, Spain
| | - Froilán Granero-Moltó
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain.,Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge María Núñez-Córdoba
- Division of Biostatistics, Research Support Service, Central Clinical Trials Unit, University of Navarra Clinic, Pamplona, Spain.,Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain.,Epidemiology and Public Health Area, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Silvia López-Elío
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Enrique Andreu
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - José María Bondía
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Andrés Valentí-Azcárate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Eva María Villarón
- Department of Hematology, Complejo Hospitalario de Salamanca, Salamanca, Spain
| | - Juan Ramón Valentí-Nin
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Felipe Prósper
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain. .,Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain.
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47
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Comparing the validity and responsiveness of the EQ-5D-5L to the Oxford hip and knee scores and SF-12 in osteoarthritis patients 1 year following total joint replacement. Qual Life Res 2018; 27:1311-1322. [PMID: 29423757 DOI: 10.1007/s11136-018-1808-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE (1) To assess responsiveness of the EQ-5D-5L compared to Oxford hip and knee scores and the SF-12 in osteoarthritis patients undergoing total hip (THR) or knee (TKR) replacement surgery; (2) to compare distribution and anchor-based methods of assessing responsiveness. METHODS Questionnaires were mailed to consecutive patients following surgeon referral for primary THR or TKR and 1 year post-surgery. We assessed effect size (ES), standardized response mean (SRM), and standard error of measurement (SEM). Minimum important difference (MID) was the mean change in patients reporting somewhat better in hip or knee, health in general, and those who were satisfied with surgery (5-point scales). Responders were compared using MID versus 1 and 2SEM. RESULTS The sample of 537 (50% TKR) was composed of 56% female with a mean age of 64 years (SD 10). EQ-5D-5L ES was 1.86 (THR) and 1.19 (TKR) compared to 3.00 and 2.05 for Oxford scores, respectively. MID for the EQ-5D-5L was 0.22 (THR) and 0.20 (TKR) for patients who rated their hip or knee as somewhat better. There was a wide variation in the MID and the percentage of responders, depending on the joint, method of assessment, and the outcome measure. The percent agreement of responder classification using 2SEM vs. MID ranged from 79.6 to 99.6% for the EQ-5D-5L and from 69.4 to 94.8% for the Oxford scores. CONCLUSIONS Responsiveness of the EQ-5D-5L was acceptable in TKR and THR. Caution should be taken in interpreting responder to TJR based on only one method of assessment.
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Roos EM. 3 steps to improve reporting and interpretation of patient-reported outcome scores in orthopedic studies. Acta Orthop 2018; 89:1-2. [PMID: 29172907 PMCID: PMC5810814 DOI: 10.1080/17453674.2017.1407058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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49
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Escobar A, García Pérez L, Herrera-Espiñeira C, Aizpuru F, Sarasqueta C, Gonzalez Sáenz de Tejada M, Quintana JM, Bilbao A. Total knee replacement: Are there any baseline factors that have influence in patient reported outcomes? J Eval Clin Pract 2017; 23:1232-1239. [PMID: 28548313 DOI: 10.1111/jep.12765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is conflicting evidence about what factors influence outcomes after total knee replacement (TKR). The objective is to identify baseline factors that differentiate patients who achieve both, minimal clinically important difference (MCID) and a patient acceptable symptom state (PASS) in pain and function, measured by WOMAC, after TKR from those who do not attain scores above the cutoff in either of these dimensions. METHODS One-year prospective multicentre study. Patients completed WOMAC, SF-12, EQ-5D, expectations, other joint problems and sociodemographic data while in the waiting list, and 1-year post-TKR. Dependent variable was a combination of MCID and PASS in both dimensions (yes/no). Univariate analysis was performed to identify variables associated. Exploratory factor analysis (EFA) was performed to study how these variables grouped into different factors. RESULTS Total sample comprised 492 patients. Mean (SD) age was 71.3 (6.9), and there were a 69.7% of women. Of the total, 106 patients did not attain either MCID or PASS in either dimension, and 230 exceeded both thresholds in both dimensions. In the univariate analysis, 13 variables were associated with belonging to one group or another. These 13 variables were included in EFA; 3 factors were extracted: expectations, mental health, and other joints problems. The percentage of variance explained by the 3 factors was 80.4%. CONCLUSION We have found 2 modifiable baseline factors, expectations and mental health, that should be properly managed by different specialist. Indication of TKR should take into account these modifiable factors for improving outcomes after TKR.
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Affiliation(s)
- A Escobar
- Research Unit, Hospital Universitario Basurto, Bilbao, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - L García Pérez
- Planning and Evaluation Service, Canary Islands Health Service, Tenerife, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - C Herrera-Espiñeira
- Hospital Virgen de las Nieves, Granada, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - F Aizpuru
- Research Unit, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - C Sarasqueta
- Research Unit, Hospital Universitario Donostia, San Sebastian, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - M Gonzalez Sáenz de Tejada
- Research Unit, Hospital Universitario Basurto, Bilbao, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - J M Quintana
- Research Unit, Hospital of Galdakao-Usansolo, Galdakao, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
| | - A Bilbao
- Research Unit, Hospital Universitario Basurto, Bilbao, Spain.,Research Associate, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Spain
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50
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Warner SC, Richardson H, Jenkins W, Kurien T, Doherty M, Valdes AM. Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement. World J Orthop 2017; 8:761-769. [PMID: 29094006 PMCID: PMC5656491 DOI: 10.5312/wjo.v8.i10.761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 06/20/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement (TJR) in people who had undergone knee or hip replacement for osteoarthritis.
METHODS Participants (n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire (PDQ) to assess neuropathic pain-like symptoms (NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiver operator characteristic (ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.
RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83 (95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79 (0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: ORsatisfied = 2.06 (95%CI: 1.15-3.69), P = 0.015.
CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.
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Affiliation(s)
- Sophie C Warner
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Leicester LE3 9QP, United Kingdom
| | - Helen Richardson
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
| | - Wendy Jenkins
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
| | - Thomas Kurien
- Arthritis Research UK Pain Centre, Nottingham NG5 1PB, United Kingdom
- Academic Division of Trauma and Orthopaedics, Queens Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham NG5 1PB, United Kingdom
| | - Ana M Valdes
- Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham NG5 1PB, United Kingdom
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