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Cervera Irimia J, Tomé-Bermejo F, Piñera-Parrilla AR, Benito Gallo M, Bisaccia M, Fernández-González M, Villar-Pérez J, Fernández-Carreira JM, Orovio de Elizaga J, Areta-Jiménez FJ, Álvarez Galovich L, Rollo G, Caruso L, Meccariello L. Spinal fusion achieves similar two-year improvement in HRQoL as total hip and total knee replacement. A prospective, multicentric and observational study. SICOT J 2019; 5:26. [PMID: 31359861 PMCID: PMC6664676 DOI: 10.1051/sicotj/2019027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/16/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Total hip and knee arthroplasty (THA/TKA) are surgical procedures with proven benefits. Although the literature reports outcomes of fusion of the lumbar spine comparable to those of THA/TKA in general health-related quality-of-life (HRQoL) questionnaires, functional assessment is nevertheless needed for these results to be of use in clinical practice and management. Aim of our study was to prove that lumbar spinal fusion has similar if not better outcomes than THA/TKA using intervention-specific HRQoL questionnaires and functional assessment questionnaires. MATERIALS AND METHODS Observational, ambispective, multicentre study of three cohorts undergoing lumbar spinal fusion (n = 115), THA (n = 119) and TKA (n = 253). Patients were evaluated using the Short-Form-12 (SF-12), Harris-Hip-Score, Hospital for Special Surgery Scale (HSS) and Oswestry Low Back Pain Disability questionnaires. A minimum follow-up of two years was conducted. RESULTS The SF-12 showed significant improvement in all groups. The SF-12 physical component summary score indicated a more severe pre-operative status (p = 0.031) in the THA cohort. The mental component summary score indicated a less severe pre-operative status in the TKA cohort (p = 0.008) and greater post-operative improvement in the TKA and THA cohorts across follow-up (six months p = 0.021; one year p = 0.012; two years p = 0.042). Functional assessment indicated greater pre-operative disability in the THA group. At two years of follow-up, functional improvement according to the Harris, HSS and Oswestry questionnaires were 152.01%, 50.07% and 41.14% respectively. CONCLUSIONS This study demonstrates that lumbar spinal fusion and total knee and hip arthroplasty are comparable in terms of functional improvement when thoroughly studied with health, quality-of-life and functional assessment questionnaires.
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Affiliation(s)
- Javier Cervera Irimia
- Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Félix Tomé-Bermejo
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain - Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Angel R Piñera-Parrilla
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Marina Benito Gallo
- Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delle Fratte, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | | | - Julio Villar-Pérez
- León University Health Care Centre, Campus de Vegazana, s/n, 24071 León, Spain
| | | | - Javier Orovio de Elizaga
- Catalonian General Hospital, Carrer Pedro i Pons, 1, Sant Cugat del Vallés, 08195 Barcelona, Spain
| | | | - Luis Álvarez Galovich
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Block A - V Floor, Piazzetta Muratore, 73100 Lecce, Italy
| | - Luigi Caruso
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delle Fratte, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Block A - V Floor, Piazzetta Muratore, 73100 Lecce, Italy
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Nguyen USDT, Perneger T, Franklin PD, Barea C, Hoffmeyer P, Lübbeke A. Improvement in mental health following total hip arthroplasty: the role of pain and function. BMC Musculoskelet Disord 2019; 20:307. [PMID: 31253128 PMCID: PMC6599341 DOI: 10.1186/s12891-019-2669-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/05/2019] [Indexed: 12/05/2022] Open
Abstract
Background Mental health has been shown to improve after total hip arthroplasty (THA). Little is known about the role of pain and function in this context. We assessed whether change in mental health was associated with improvement in pain and function 1 year post-surgery. Methods This prospective study included patients enrolled in a THA registry from 2010 to 2014. We examined the mental component score (MCS) before and 1 year post-surgery, and 1-year change, in association with Western Ontario McMaster Universities (WOMAC) pain and function scores. All scores were normalized, ranging from 0 to 100 (larger score indicating better outcome). Analyses were adjusted for potential confounders. Results Our study included 610 participants, of which 53% were women. Descriptive statistics are as follows: the average (SD) for age (years) was 68.5 (11.8), and for BMI was 26.9 (4.9). In addition, the MCS average (SD) at baseline was 44.7 (11.2), and at 1-year after THA was 47.5 (10.5). The average change from baseline to 1-year post-THA in MCS was 2.8 (95% CI: 1.9, 3.6), for an effect size of 0.26. As for the WOMAC pain score, the average change from baseline to 1-year post-THA was 44.2 (95%CI: 42.4, 46.0), for an effect size of 2.5. The equivalent change in WOMAC function was 38.1 (95% CI: 36.2, 40.0), for an effect size of 2.0. Results from multivariable analysis controlling for covariates showed that an improvement of 10 points in the 1-year change in pain score resulted in a 0.78 point (95%: CI 0.40, 1.26) increase in the 1-year change in MCS, whereas a 10-point improvement in the 1-year change in function was associated with a 0.94 point (95% CI: 0.56, 1.32) increase. Conclusions Mental health significantly improved from baseline to 1-year post-THA. Greater improvement in pain and function was associated with greater improvement in mental health 1 year post-THA.
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Affiliation(s)
- Uyen-Sa D T Nguyen
- Department of Orthopedics & Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, UK. .,Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Thomas Perneger
- Clinical Epidemiology Service, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Patricia D Franklin
- Department of Orthopedics & Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, UK.,Department of Medical Social Science, Northwestern University Feinberg School of Medicine, 633 St. Clair St, 19th floor, Chicago, IL, 60611, USA
| | - Christophe Barea
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Anne Lübbeke
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
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Mannion AF, Impellizzeri FM, Leunig M, Jeszenszy D, Becker HJ, Haschtmann D, Preiss S, Fekete TF. EUROSPINE 2017 FULL PAPER AWARD: Time to remove our rose-tinted spectacles: a candid appraisal of the relative success of surgery in over 4500 patients with degenerative disorders of the lumbar spine, hip or knee. Eur Spine J 2018; 27:778-788. [PMID: 29460013 DOI: 10.1007/s00586-018-5469-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/06/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Studies comparing the outcome of spine surgery with that of large-joint replacement report equivocal findings. The patient-reported outcome measures (PROMs) used in such studies are typically generic and may not be sufficiently sensitive to the successes/failures of treatment. This study compared different indices of "success" in patients undergoing surgery for degenerative disorders of the lumbar spine, hip, or knee, using a validated, multidimensional, and joint-specific PROM. METHODS Preoperatively and 12 months postoperatively, 4594 patients (3937 lumbar spine, 368 hip, 269 knee) undergoing first-time surgery completed a PROM that included the Core Outcome Measures Index (COMI) for the affected joint. The latter comprises a set of single items on pain, function, symptom-specific well-being, quality of life, and disability-all in relation to the specified joint problem. Other single-item ratings of treatment success were made 12 months postoperatively. RESULTS In multiple regression analyses, controlling for confounders, the mean improvement in COMI at 12 months was greatest for the hip patients and lowest for those with degenerative spinal deformity (= the statistical reference group) (p < 0.05). Compared with spinal deformity, the odds of achieving "success" were: higher for hip (OR 4.6; 95% CI 2.5-8.5) and knee (OR 4.0; 95% CI 2.1-7.7) (no difference between spine subgroups) for "satisfaction with care"; higher for hip (OR 16.9; 95% CI 7.3-39.6), knee (OR 6.3; 95% CI 3.4-11.6), degenerative spondylolisthesis (OR 1.6; 95% CI 1.2-2.2), and herniated disc (OR 1.7; 95% CI 1.2-2.4) for "global treatment outcome"; and higher for hip (OR 13.8; 95% CI 8.8-21.6), knee (OR 5.3; 95% CI 3.6-7.8), degenerative spondylolisthesis (OR 1.6; 95% CI 1.3-2.1), and herniated disc (1.5; 95% CI 1.1-2.0) for "patient-acceptable symptom state". Patient-rated complications were the greatest in degenerative spinal deformity (29%) and the lowest in hip (18%). CONCLUSIONS The current study is the largest of its kind and the first to use a common, but joint-specific instrument to report patient-reported outcomes after surgery for degenerative disorders of the spine, hip, or knee. The findings provide a sobering account of the significantly poorer outcomes after spine surgery compared with large-joint replacement. Further work is required to hone the indications and patient selection criteria for spine surgery. The data should be used to lobby research funding-bodies, governmental agencies, industry, and charitable foundations to invest more in spine research/registries, in the hope of ultimately improving spine outcomes. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Franco M Impellizzeri
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Michael Leunig
- Department of Hip and Knee Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dezsö Jeszenszy
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Hans-Jürgen Becker
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Stefan Preiss
- Department of Hip and Knee Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamas F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Rampersaud YR, Lewis SJ, Davey JR, Gandhi R, Mahomed NN. Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee--part 1: long-term change in health-related quality of life. Spine J 2014; 14:234-43. [PMID: 24325880 DOI: 10.1016/j.spinee.2013.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It is well accepted that total hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health-related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes with THA/TKA after surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome after LSS surgery compared with THA/TKA remains uncertain. PURPOSE The primary purpose of this study is to assess whether improvements in HRQoL after surgical management of focal lumbar spinal stenosis (FLSS) with or without spondylolisthesis are sustainable over the long term compared with that of THA/TKA for OA. STUDY DESIGN Single-center, retrospective, longitudinal matched cohort study of prospectively collected outcomes, with a minimum of 5-year follow-up (FU). PATIENT SAMPLE Patients who had primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary OA. OUTCOME MEASURES Postoperative change from baseline to last FU in Short-Form 36 physical component summary (PCS) and mental component summary (MCS) scores among groups was used as the primary outcome measure. METHODS An age, sex-matched inception cohort of primary one- to two-level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared with a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was used for the primary analysis. RESULTS Mean (percent) FUs in months were 80.5+16.04 (79%), 94.6+16.62 (92%), and 80.6+16.84 (85%) for the FLSS, THA, and TKA cohorts, respectively, with a range of 5 to 10 years for all three cohorts. The number of patients who have undergone revision including those lost to FU for the FLSS, THA, and TKA cohorts were n=20 (20.2%, same site [n=7] and adjacent segment [n=13]) requiring 27 operations, n=3 (3%, same site) requiring 5 operations, and n=8 (8.1%, same site) requiring 12 operations, respectively (p<.01). The average time to first revision was 56/65/43 months, respectively. Mean postoperative PCS (p<.0001) and MCS (p<.02) scores improved significantly and were durable for all groups at the last FU. The mean changes from baseline PCS/MCS scores to last FU were 8.5/6.4, 12.3/7.0, and 8.3/4.9 for FLSS, THA, and TKA, respectively. Adjusting for baseline age, sex, body mass index, PCS score, and MCS score, there was a strong trend in favor of greater sustained change in the PCS score of THA over FLSS (p=.07) and TKA (p=.08). No difference was noted for change in PCS score between FLSS and TKA (p=.95). No differences were noted for change in MCS score among all three cohorts (p>.1). CONCLUSIONS Significant improvements in HRQoL after surgical treatment of FLSS with or without spondylolisthesis and hip and knee OA are sustained for a mean of 7 to 8 years, with a minimum of 5-year FU. Despite a higher revision rate, patients undergoing surgery for FLSS can expect a comparable long-term average improvement in HRQoL from baseline compared with their peers undergoing TKA and to a lesser extent THA.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - J Roderick Davey
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Rampersaud YR, Tso P, Walker KR, Lewis SJ, Davey JR, Mahomed NN, Coyte PC. Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 2--estimated lifetime incremental cost-utility ratios. Spine J 2014; 14:244-54. [PMID: 24239803 DOI: 10.1016/j.spinee.2013.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 08/22/2013] [Accepted: 11/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been widely accepted as highly cost-effective procedures, spine surgery for the treatment of degenerative conditions does not share the same perception among stakeholders. In particular, the sustainability of the outcome and cost-effectiveness following lumbar spinal stenosis (LSS) surgery compared with THA/TKA remain uncertain. PURPOSE The purpose of the study was to estimate the lifetime incremental cost-utility ratios for decompression and decompression with fusion for focal LSS versus THA and TKA for osteoarthritis (OA) from the perspective of the provincial health insurance system (predominantly from the hospital perspective) based on long-term health status data at a median of 5 years after surgical intervention. STUDY DESIGN/SETTING An incremental cost-utility analysis from a hospital perspective was based on a single-center, retrospective longitudinal matched cohort study of prospectively collected outcomes and retrospectively collected costs. PATIENT SAMPLE Patients who had undergone primary one- to two-level spinal decompression with or without fusion for focal LSS were compared with a matched cohort of patients who had undergone elective THA or TKA for primary OA. OUTCOME MEASURES Outcome measures included incremental cost-utility ratio (ICUR) ($/quality adjusted life year [QALY]) determined using perioperative costs (direct and indirect) and Short Form-6D (SF-6D) utility scores converted from the SF-36. METHODS Patient outcomes were collected using the SF-36 survey preoperatively and annually for a minimum of 5 years. Utility was modeled over the lifetime and QALYs were determined using the median 5-year health status data. The primary outcome measure, cost per QALY gained, was calculated by estimating the mean incremental lifetime costs and QALYs for each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses adjusting for +25% primary and revision surgery cost, +25% revision rate, upper and lower confidence interval utility score, variable inpatient rehabilitation rate for THA/TKA, and discounting at 5% were conducted to determine factors affecting the value of each type of surgery. RESULTS At a median of 5 years (4-7 years), follow-up and revision surgery data was attained for 85%-FLSS, 80%-THA, and 75%-THA of the cohorts. The 5-year ICURs were $21,702/QALY for THA; $28,595/QALY for TKA; $12,271/QALY for spinal decompression; and $35,897/QALY for spinal decompression with fusion. The estimated lifetime ICURs using the median 5-year follow-up data were $5,682/QALY for THA; $6,489/QALY for TKA; $2,994/QALY for spinal decompression; and $10,806/QALY for spinal decompression with fusion. The overall spine (decompression alone and decompression and fusion) ICUR was $5,617/QALY. The estimated best- and worst-case lifetime ICURs varied from $1,126/QALY for the best-case (spinal decompression) to $39,323/QALY for the worst case (spinal decompression with fusion). CONCLUSION Surgical management of primary OA of the spine, hip, and knee results in durable cost-utility ratios that are well below accepted thresholds for cost-effectiveness. Despite a significantly higher revision rate, the overall surgical management of FLSS for those who have failed medical management results in similar median 5-year and lifetime cost-utility compared with those of THA and TKA for the treatment of OA from the limited perspective of a public health insurance system.
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Affiliation(s)
- Y Raja Rampersaud
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8.
| | - Peggy Tso
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
| | - Kevin R Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
| | - Stephen J Lewis
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - J Roderick Davey
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - Nizar N Mahomed
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
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Rampersaud YR, Wai EK, Fisher CG, Yee AJM, Dvorak MFS, Finkelstein JA, Gandhi R, Abraham EP, Lewis SJ, Alexander DI, Oxner WM, Davey JR, Mahomed N. Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis. Spine J 2011; 11:1033-41. [PMID: 22122836 DOI: 10.1016/j.spinee.2011.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 07/20/2011] [Accepted: 10/22/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT The results of single-center studies have shown that surgical intervention for lumbar spinal stenosis yielded comparable health-related quality of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these results are generalizable to routine clinical practice in Canada is unknown. PURPOSE The primary purpose of this equivalence study was to compare the relative improvement in physical HRQoL after surgery for focal lumbar spinal stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six Canadian centers. STUDY DESIGN/SETTING A Canadian multicenter ambispective cohort study. PATIENT SAMPLE A cohort of 371 primary one- to two-level spinal decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip (n=156) and knee (n=208) arthroplasty for OA. OUTCOME MEASURES The primary outcome was the change in preoperative to 2-year postoperative 36-Item Short Form Health Survey Physical Component Summary (PCS) score as reflected by the number of patients reaching minimal clinically important difference (MCID) and substantial clinical benefit (SCB). METHODS Univariate analyses were conducted to identify baseline differences and factors that were significantly related to outcomes at 2 years. Multivariable regression modeling was used as our primary analysis to compare outcomes between groups. RESULTS The mean age (years) and percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, and 65.8/64.3, respectively. All three groups experienced significant improvement of baseline PCS (p<.001). Multivariate analyses, adjusting for baseline differences (age, gender, baseline Mental Component Summary score, baseline PCS), demonstrated no significant differences in PCS outcome between spinal surgery and arthroplasty (combined hip and knee cohorts) patients with an odds ratio of 0.80 (95% confidence interval [CI], 0.57-1.11; p=.17) and 0.79 (95% CI, 0.58-1.09; p=.15) for achieving MCID or SCB, respectively. In subgroup analysis, spine and knee outcomes were not significantly different, with hip arthroplasty superior to both (p<.0001). CONCLUSIONS Significant improvement in physical HRQoL after surgical treatment of FLSS (including DLS) is consistently achieved nationally. Our overall results demonstrate that a comparable number of patients can expect to achieve MCID and SCB 2 years after surgical intervention for FLSS and total knee arthroplasty.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Petersen MK, Andersen NT, Søballe K. Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: a follow-up study involving 61 patients. Acta Orthop 2008; 79:160-7. [PMID: 18473252 DOI: 10.1080/17453670710014932] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Fast-track surgery has been reported to improve rehabilitation outcome after major surgery, with length of hospitalization and muscle strength as outcome measures. We assessed the effect of optimization of perioperative care during admission on self-reported functional outcome, and compared patient status 6 months after THR with an age-matched healthy cohort. PATIENTS AND METHODS 79 THR patients were randomized to optimized perioperative care (OPC) or conventional perioperative care (CPC). 61 patients fulfilled the requirements of the study protocol. Endpoint outcome was measured by SF-36 and WOMAC. To compare functional outcome in the THR group with that in healthy controls, we used data from a representative sample of 4,098 non-institutionalized Danish adults collected by the Danish National Institute of Public Health. RESULTS We found similar improvements in SF-36 and WOMAC scores for the OPC and CPC groups postoperatively, except for the total WOMAC score and the WOMAC subscore "function"-in which the CPC group did statistically significantly better. The OPC and CPS groups had similar score levels. 6 months after surgery, THR patients scored higher overall in the general health subscale and lower in three physical subscales of SF-36 compared to age-matched healthy controls. Interpretation We found no evidence for the effect of optimization strategies during admission on self-reported functional outcome after THR. Although THR patients improved considerably after treatment, their physical status remained below the level of the healthy controls. Our results may indicate that the potential for functional improvement in THR patients is not fully realized, but this must be studied further.
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Affiliation(s)
- Mette K Petersen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.
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