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Kaya C, Seyman CC, Kaya Y. Determination of the effect of preoperative knee joint function on postoperative quality of life in patients with total knee arthroplasty. J Orthop Res 2024. [PMID: 38734879 DOI: 10.1002/jor.25876] [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: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
Primary total knee arthroplasty (TKA) is one of the most successful procedures for end-stage knee osteoarthritis. To determine the effect of preoperative knee joint function on postoperative quality of life in patients undergoing primary TKA. This descriptive cross-sectional study was conducted with a total of 208 patients in the orthopedics and traumatology clinic. Data were gathered with a personal information form, the Oxford Knee Score (OKS), and the EQ-5D-5L Quality Of Life Scale in the preoperative period, at postoperative 6th week, and at postoperative 3rd month. The data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), correlation analysis, and simple linear regression analysis. The mean age of the patients was 65.65 ± 7.01 years. Most patients (86.1%) were women, and 51.4% underwent left TKA. OKS scores indicated poor knee function preoperatively and gradually increased at postoperative 6th week and 3rd month. Preoperative OKS was a significant predictor of postoperative knee joint function and quality of life. This study shows that preoperative knee joint function significantly affects postoperative knee joint function and quality of life. These results demonstrate the importance of the surgery timing and suggest that performing surgery earlier in functional decline may be associated with a better outcome.
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Affiliation(s)
- Cigdem Kaya
- Department of Surgical Nursing, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - Cigdem Canbolat Seyman
- Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Yılmaz Kaya
- Department of Orthopedics and Traumatology, Balıkesir State Hospital, Balıkesir, Turkey
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2
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Dakin H, Tsiachristas A. Rationing in an Era of Multiple Tight Constraints: Is Cost-Utility Analysis Still Fit for Purpose? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:315-329. [PMID: 38329700 PMCID: PMC7615833 DOI: 10.1007/s40258-023-00858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
Cost-utility analysis may not be sufficient to support reimbursement decisions when the assessed health intervention requires a large proportion of the healthcare budget or when the monetary healthcare budget is not the only resource constraint. Such cases include joint replacement, coronavirus disease 2019 (COVID-19) interventions and settings where all resources are constrained (e.g. post-COVID-19 or in low/middle-income countries). Using literature on health technology assessment, rationing and reimbursement in healthcare, we identified seven alternative frameworks for simultaneous decisions about (dis)investment and proposed modifications to deal with multiple resource constraints. These frameworks comprised constrained optimisation; cost-effectiveness league table; 'step-in-the-right-direction' approach; heuristics based on effective gradients; weighted cost-effectiveness ratios; multicriteria decision analysis (MCDA); and programme budgeting and marginal analysis (PBMA). We used numerical examples to demonstrate how five of these alternative frameworks would operate. The modified frameworks we propose could be used in local commissioning and/or health technology assessment to supplement standard cost-utility analysis for interventions that have large budget impact and/or are subject to additional constraints.
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Affiliation(s)
- Helen Dakin
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, Headington, OX3 7LF, Oxford, UK.
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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3
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Appiah KOB, Khunti K, Kelly BM, Innes AQ, Liao Z, Dymond M, Middleton RG, Wainwright TW, Yates T, Zaccardi F. Patient-rated satisfaction and improvement following hip and knee replacements: Development of prediction models. J Eval Clin Pract 2023; 29:300-311. [PMID: 36172971 DOI: 10.1111/jep.13767] [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: 04/13/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE Effective preoperative assessments of determinants of health status and function may improve postoperative outcomes. AIMS AND OBJECTIVES We developed risk scores of preoperative patient factors and patient-reported outcome measures (PROMs) as predictors of patient-rated satisfaction and improvement following hip and knee replacements. PATIENTS AND METHODS Prospectively collected National Health Service and independent sector patient data (n = 30,457), including patients' self-reported demographics, comorbidities, PROMs (Oxford Hip/Knee score (OHS/OKS) and European Quality of Life (EQ5D index and health-scale), were analysed. Outcomes were defined as patient-reported satisfaction and improvement following surgery at 7-month follow-up. Univariable and multivariable-adjusted logistic regressions were undertaken to build prediction models; model discrimination was evaluated with the concordance index (c-index) and nomograms were developed to allow the estimation of probabilities. RESULTS Of the 14,651 subjects with responses for satisfaction following hip replacements 564 (3.8%) reported dissatisfaction, and 1433 (9.2%) of the 15,560 following knee replacement reported dissatisfaction. A total of 14,662 had responses for perceived improvement following hip replacement (lack of improvement in 391; 2.7%) and 15,588 following knee replacement (lack of improvements in 1092; 7.0%). Patients reporting poor outcomes had worse preoperative PROMs. Several factors, including age, gender, patient comorbidities and EQ5D, were included in the final prediction models: C-indices of these models were 0.613 and 0.618 for dissatisfaction and lack of improvement, respectively, for hip replacement and 0.614 and 0.598, respectively, for knee replacement. CONCLUSIONS Using easily accessible preoperative patient factors, including PROMs, we developed models which may help predict dissatisfaction and lack of improvement following hip and knee replacements and facilitate risk stratification and decision-making processes.
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Affiliation(s)
- Karen O B Appiah
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration-East Midlands (ARC-EM), University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | | | | | | | | | - Robert G Middleton
- Nuffield Health, Epsom Gateway, Epsom, UK.,Orthopaedic Research Institute, Bournemouth University, Poole, UK
| | - Thomas W Wainwright
- Nuffield Health, Epsom Gateway, Epsom, UK.,Orthopaedic Research Institute, Bournemouth University, Poole, UK
| | - Thomas Yates
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK
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Factors associated with a clinically significant improvement in health-related quality of life after total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03460-3. [PMID: 36565341 PMCID: PMC9789371 DOI: 10.1007/s00590-022-03460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim was to identify independent preoperative factors associated with changes in health-related quality of life (HRQoL) following total knee arthroplasty (TKA), and whether these could be used as indicators for surgery. METHODS A retrospective study of 3127 TKA patients was undertaken that included 1194 (38.2%) male and 1933 (61.8%) female patients, with a mean age of 70.5 years (standard deviation 9.0). Patient demographics, body mass index and ASA grade, Oxford Knee Score (OKS) and EuroQol 5-dimension (EQ-5D) 3-level, which was used to assess HRQoL, were collected preoperatively and 2 years postoperatively. RESULTS When adjusting for confounding factors, obesity grade II (p = 0.002), ASA grade 3 (p = 0.002), and a better preoperative OKS (p < 0.001) or EQ-5D score (p < 0.001) were associated with a decreased improvement in the HRQoL at 2-years. A preoperative EQ-5D of < 0.8 (95.7% specific, AUC ≥ 67.0%) or an OKS of < 36 (97.1% specific, AUC ≥ 58.1%) was associated with a clinically significant improvement HRQoL. Patella resurfacing (n = 1454, 46.5%) was not independently associated with a clinical or statistically significant improvement in HRQoL. According to preoperative factors, no subgroup of patients benefited more from patella resurfacing according to improvement in their HRQoL. CONCLUSION ASA grade 3, grade II obesity, a better preoperative EQ-5D or OKS were independently associated with a lesser improvement in HRQoL. The thresholds identified in the EQ-5D or OKS for a clinically significant improvement in HRQoL may be used as potential indicators for referral for TKA. Patella resurfacing was not independently associated with a clinically important improvement in HRQoL. LEVEL OF EVIDENCE Retrospective diagnostic study, Level III.
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Badge H, Churches T, Naylor JM, Xuan W, Armstrong E, Gray L, Fletcher J, Gosbell I, Christine Lin CW, Harris IA. Association between VTE and antibiotic prophylaxis guideline compliance and patient-reported outcomes after total hip and knee arthroplasty: an observational study. J Patient Rep Outcomes 2022; 6:110. [PMID: 36224453 PMCID: PMC9556685 DOI: 10.1186/s41687-022-00502-6] [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: 03/23/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) and venous thromboembolism (VTE) are associated with high burden and cost and are considered largely preventable following total knee or hip arthroplasty (TKA, THA). The risk of developing VTE and SSI is reduced when prophylaxis is compliant with evidence-based clinical guidelines. However, the association between VTE and antibiotic prophylaxis clinical guideline compliance and patient-reported outcome measures (PROMs) after THA/TKA is unknown. This study aims to explore whether care that is non-compliant with VTE and antibiotic guideline recommendations is associated with PROMs (Oxford Hip/Knee Score and EQ-5D Index scores) at 90- and 365-days after surgery. METHODS This prospective observational study included high-volume arthroplasty public and private sites and consenting eligible participants undergoing elective primary THA/TKA. We conducted multiple linear regression and linear mixed-effects modelling to explore the associations between non-compliance with VTE and antibiotic guidelines, and PROMs. RESULTS The sample included 1838 participants. Compliance with VTE and antibiotic guidelines was 35% and 13.2% respectively. In adjusted modelling, non-compliance with VTE guidelines was not associated with 90-day Oxford score (β = - 0.54, standard error [SE] = 0.34, p = 0.112) but was significantly associated with lower (worse) 365-day Oxford score (β = - 0.76, SE = 0.29, p = 0.009), lower EQ-5D Index scores at 90- (β = - 0.02 SE = 0.008, p = 0.011) and 365-days (β = - 0.03, SE = 0.008, p = 0.002).. The changes in Oxford and EQ-5D Index scores were not clinically important. Noncompliance with antibiotic guidelines was not associated with either PROM at 90- (Oxford: β = - 0.45, standard error [SE] = 0.47, p = 0.341; EQ-5D: β = - 0.001, SE = 0.011, p = 0.891) or 365-days (Oxford score: β = - 0.06, SE = 0.41, p = 0.880 EQ-5D: β = - 0.010, SE = 0.012, p = 0.383). Results were consistent when complications were included in the model and in linear mixed-effects modelling with the insurance sector as a random effect. CONCLUSIONS Non-compliance with VTE prophylaxis guidelines, but not antibiotic guidelines, is associated with statistically significant but not clinically meaningful differences in Oxford scores and EQ-5D Index scores at 365 days.
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Affiliation(s)
- Helen Badge
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.411958.00000 0001 2194 1270Australian Catholic University, 8-20 Napier Street, North Sydney, 2060 Australia
| | - Tim Churches
- grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Justine M. Naylor
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Wei Xuan
- grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Elizabeth Armstrong
- grid.1005.40000 0004 4902 0432School of Population Health, The University of New South Wales, High St Kensington, Kensington, NSW 2052 Australia
| | - Leeanne Gray
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071 Australia
| | - John Fletcher
- grid.1013.30000 0004 1936 834XUniversity of Sydney, Fisher Road, Camperdown, NSW 2006 Australia ,grid.413252.30000 0001 0180 6477Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145 Australia
| | - Iain Gosbell
- grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1029.a0000 0000 9939 5719Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Chung-Wei Christine Lin
- grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Edward Ford Building (A27) Fisher Road, Camperdown, NSW 2006 Australia
| | - Ian A. Harris
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071 Australia
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Hadjimichael AC, Foukas AF, Kaspiris A, Vasileiou D, Kamariotis S, Stylianakis A, Vasiliadis ES, Savvidou OD, Antonopoulos A. Sonication of revised hip and knee prostheses detects occult infections, improves clinical outcomes and prevents re - revisions. A case series study. Infect Prev Pract 2022; 4:100232. [PMID: 35935264 PMCID: PMC9352915 DOI: 10.1016/j.infpip.2022.100232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Periprosthetic joint infection (PJI) is a devastating complication occurring in 1–2% of primary and up to 10% of revised total hip and knee arthroplasties (THA and TKA) impairing patient's quality of life. Occult infections are underdiagnosed, sub-treated and sub-clinically experienced by patients. This study aimed to correlate patients' clinical outcomes with early antibiotic treatment based on use or non-use of a sonication technique on explanted prostheses. Methods 33 patients with revised THA or TKA were retrospectively evaluated. Clinical outcomes were assessed via Oxford hip or knee scores, and correlated with administration or not of antibiotic treatment based on sonication results. Results According to laboratory findings the patients were divided in the following three groups: 1. Septic loosening (conventional cultures and/or sonication positive), 2. Aseptic loosening (conventional cultures and sonication negative) and 3. Occult loosening (conventional cultures negative, sonication not performed). The average Oxford score was poor (27.9/60) for the septic, excellent (43.8/60) for the aseptic and intermediate (37.7/60) for the occult group. Additionally, conventional cultures were negative, but sonication-positive, in 6 individuals with patient-related risk factors (male gender, BMI > 30 kg/m2, diabetes, hypertension, steroids and rheumatoid arthritis). Conclusions Sonication represents a valuable diagnostic technique to guide administration of effective antibiotic treatment for patients, especially for detection of persistent post-revision occult infections. We recommend the systematic investigation of revised prostheses with a sonication technique, but especially in cases with risk factors for infection who it is suspected may have occult loosening.
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Affiliation(s)
- Argyris C Hadjimichael
- Department of Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, W2 1NY, London, UK
| | - Athanasios F Foukas
- Third Department of Orthopaedic Surgery, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras 26504, Greece
| | - Dimitris Vasileiou
- Orthopaedic Department, Mediterranean Hospital of Cyprus, Stygos 9, 3117, Limassol, Cyprus
| | - Spyros Kamariotis
- Microbiology Department, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece
| | - Antonios Stylianakis
- Microbiology Department, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece
| | - Elias S Vasiliadis
- Third Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Faculty of Medicine, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Faculty of Medicine, Attikon University Hospital, Athens,1 Rimini Street, Chaidari,12462, Athens, Greece
| | - Athanasios Antonopoulos
- Third Department of Orthopaedic Surgery, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece
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Clement ND, Afzal I, Liu P, Phoon KM, Asopa V, Sochart DH, Kader DF. The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty. ARTHROPLASTY 2022; 4:33. [PMID: 35918759 PMCID: PMC9345743 DOI: 10.1186/s42836-022-00132-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The health-related quality of life of patients awaiting a total knee arthroplasty (TKA) deteriorates with increasing time to surgery and identification of those with the worst quality of life may help to prioritize patients. The aims were to identify and validate independent variable(s) associated with a health state worse than death (WTD) in patients awaiting a TKA and whether these variables influenced patients-reported outcome measures. METHODS A retrospective cohort of 5857 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, body mass index (BMI), index of multiple deprivation, Oxford Knee Score (OKS), EuroQoL five dimension (EQ-5D) 3 level, and visual analogue scale (EQ-VAS) were collected preoperatively and one year postoperatively. An EQ-5D utility of less than zero was defined as WTD. A randomly selected subset of patients (n = 3076) was used to validate the variable that was most predictive of a state WTD and to assess the influence on patient-reported outcomes. RESULTS There were 771 (13.2%) patients with a health state WTD. Increasing social deprivation (P = 0.050), worse preoperative OKS (P < 0.001), or EQ-VAS (P < 0.001) were independently associated with a health state WTD. The OKS was the most reliable predictor (area under curve 88.9%, 95% CI 87.8 to 90.1, P < 0.001) of a health state WTD. A threshold value of 16 or less, 80% sensitive and specific, was validated and confirmed to have a negative predictive value of 97.5%. Patients with an OKS of 16 or less had a significantly greater improvement in their OKS (difference 6.9, P < 0.001) and EQ-5D score (difference 0.257, P < 0.001). When adjusting for confounding factors, a health status WTD was not associated with worse postoperative OKS (difference -0.6, 95% CI -1.4 to 0.3, P = 0.177), EQ-5D (difference -0.016, 95% CI -0.036 to 0.003, P = 0.097) or patient satisfaction (difference -1.8, 95% CI -4.3 to 0.7, P = 0.162). CONCLUSION A threshold score 16 or less in OKS was a reliable predictor of a health status WTD and was associated with a greater improvement in knee-specific and health-related quality of life following TKA.
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Affiliation(s)
- N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
- Southwest London Elective Orthopaedic Centre, Epsom, UK.
| | - I Afzal
- Southwest London Elective Orthopaedic Centre, Epsom, UK
| | - P Liu
- Southwest London Elective Orthopaedic Centre, Epsom, UK
| | - K M Phoon
- Southwest London Elective Orthopaedic Centre, Epsom, UK
| | - V Asopa
- Southwest London Elective Orthopaedic Centre, Epsom, UK
| | - D H Sochart
- Southwest London Elective Orthopaedic Centre, Epsom, UK
| | - D F Kader
- Southwest London Elective Orthopaedic Centre, Epsom, UK
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Farrow L, Ashcroft GP, Zhong M, Anderson L. Using Artificial Intelligence to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY): Protocol for the Development of a Clinical Prediction Model. JMIR Res Protoc 2022; 11:e37092. [PMID: 35544289 PMCID: PMC9133991 DOI: 10.2196/37092] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Hip and knee osteoarthritis is substantially prevalent worldwide, with large numbers of older adults undergoing joint replacement (arthroplasty) every year. A backlog of elective surgery due to the COVID-19 pandemic, and an aging population, has led to substantial issues with access to timely arthroplasty surgery. A potential method to improve the efficiency of arthroplasty services is by increasing the percentage of patients who are listed for surgery from primary care referrals. The use of artificial intelligence (AI) techniques, specifically machine learning, provides a potential unexplored solution to correctly and rapidly select suitable patients for arthroplasty surgery. OBJECTIVE This study has 2 objectives: (1) develop a cohort of patients with referrals by general practitioners regarding assessment of suitability for hip or knee replacement from National Health Service (NHS) Grampian data via the Grampian Data Safe Haven and (2) determine the demographic, clinical, and imaging characteristics that influence the selection of patients to undergo hip or knee arthroplasty, and develop a tested and validated patient-specific predictive model to guide arthroplasty referral pathways. METHODS The AI to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY) project will be delivered through 2 linked work packages conducted within the Grampian Data Safe Haven and Safe Haven Artificial Intelligence Platform. The data set will include a cohort of individuals aged ≥16 years with referrals for the consideration of elective primary hip or knee replacement from January 2015 to January 2022. Linked pseudo-anonymized NHS Grampian health care data will be acquired including patient demographics, medication records, laboratory data, theatre records, text from clinical letters, and radiological images and reports. Following the creation of the data set, machine learning techniques will be used to develop pattern classification and probabilistic prediction models based on radiological images. Supplemental demographic and clinical data will be used to improve the predictive capabilities of the models. The sample size is predicted to be approximately 2000 patients-a sufficient size for satisfactory assessment of the primary outcome. Cross-validation will be used for development, testing, and internal validation. Evaluation will be performed through standard techniques, such as the C statistic (area under curve) metric, calibration characteristics (Brier score), and a confusion matrix. RESULTS The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed. CONCLUSIONS This project provides a first step toward delivering an automated solution for arthroplasty selection using routinely collected health care data. Following appropriate external validation and clinical testing, this project could substantially improve the proportion of referred patients that are selected to undergo surgery, with a subsequent reduction in waiting time for arthroplasty appointments. TRIAL REGISTRATION ISRCTN Registry ISRCTN18398037; https://www.isrctn.com/ISRCTN18398037. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37092.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Grampian Orthopaedics, National Health Service Grampian, Aberdeen, United Kingdom
| | - George Patrick Ashcroft
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Grampian Orthopaedics, National Health Service Grampian, Aberdeen, United Kingdom
| | - Mingjun Zhong
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Lesley Anderson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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9
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Aggarwal A, Naylor JM, Adie S, Liu VK, Harris IA. Preoperative Factors and Patient-Reported Outcomes After Total Hip Arthroplasty: Multivariable Prediction Modeling. J Arthroplasty 2022; 37:714-720.e4. [PMID: 34990754 DOI: 10.1016/j.arth.2021.12.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although total hip arthroplasty (THA) has been established as a cost-effective intervention, some patients experience ongoing pain and dissatisfaction. There is interest in predicting postoperative outcomes based on preoperative data, but the relative contribution of different preoperative factors is unclear. The study's aim was to develop multivariable prediction models for the assessment of patient-reported outcomes. METHOD Registry data on 1412 patients undergoing THA for osteoarthritis at two hospitals between 2013 and 2018 was used. Potential predictors included age, sex, body mass index, spoken language, education level, previous THA, American Society of Anaesthesiologists (ASA) score, lower back pain, depression/anxiety, other lower limb arthritis, number of other comorbidities, the preoperative expectation of pain and function, EuroQol Visual Analogue Scale (EQ-VAS) and preoperative OHS. Radiographic scores were also used: joint space narrowing (JSN), osteophytes, sclerosis, and an overall grade based on the Kellgren-Lawrence (KL) classification. Outcomes assessed were the patient-rated improvement, satisfaction, and OHS at six months. RESULTS JSN or overall KL scores were the most important predictors (P < .001) for all outcomes, with better radiographic scores associated with worse outcomes. Other predictors associated with poorer outcomes were lower back pain and lower expectation (predicting poor improvement), lower education and higher ASA (predicting lower satisfaction) and younger age, female sex, non-English speakers, lower preoperative EQ-VAS, lower education, back pain, and anxiety/depression (predicting lower OHS). CONCLUSION Preoperative radiological scores are an important predictor of patient-reported outcomes at six months postoperatively. Understanding the relative strengths and significance of different factors in predicting outcomes will help the clinician and patient decision-making for THA.
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Affiliation(s)
- Ashwin Aggarwal
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
| | - Sam Adie
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; St George Hospital, New South Wales, Australia
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia
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10
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Walker RW, Whitehouse SL, Howell JR, Hubble MJW, Timperley AJ, Wilson MJ, Kassam AAM. Is rationing of total hip arthroplasty justified? Working to optimize patient accessibility to surgery using long-term patient-reported outcome data. Bone Jt Open 2022; 3:196-204. [PMID: 35253478 PMCID: PMC8965784 DOI: 10.1302/2633-1462.33.bjo-2021-0204.r1] [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: 11/05/2022] Open
Abstract
Aims The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients’ access to THA and outcomes. Methods Patients undergoing primary THA at our institution with an OHS both preoperatively and at least four years postoperatively were included. Rationing thresholds were explored to identify possible deprivation of OHS improvement. Results Overall, 2,341 patients were included. Mean OHS was 19.7 (SD 8.2) preoperatively and 39.7 (SD 9.8) at latest follow-up. An improvement of at least eight-points, the minimally important change (MIC), was seen in 2,072 patients (88.5%). The mean improvement was 20.0 points (SD 10.5). If a rationing threshold of OHS of 20 points had been enforced, 90.8% of those treated would have achieved the MIC, but only 54.3% of our cohort would have had access to surgery; increasing this threshold to 32 would have enabled 89.5% of those treated to achieve the MIC while only depriving 6.5% of our cohort. The ‘rationed’ group of OHS > 20 had significantly better OHS at latest follow-up (42.6 vs 37.3; p < 0.001), while extending the rationing threshold above 32 showed postoperative scores were more significantly affected by the ceiling effect of the OHS. Conclusion The OHS was not designed as a tool to ration healthcare, but if it had been used at our institution for this cohort, applying an OHS threshold of 20 to routine THA access would have excluded nearly half of patients from having a THA; a group in which over 85% had a significant improvement in OHS. Where its use for rationing is deemed necessary, use of a higher threshold may be more appropriate to ensure a better balance between patient access to treatment and chances of achieving good to excellent outcomes. Cite this article: Bone Jt Open 2022;3(3):196–204.
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Affiliation(s)
- Robert W. Walker
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Sarah L. Whitehouse
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Queensland University of Technology, Brisbane, Australia
| | - Jonathan R. Howell
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Matthew J. W. Hubble
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - A. John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Matthew J. Wilson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Al-Amin M. Kassam
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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11
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Sabah SA, Hedge EA, Abram SGF, Alvand A, Price AJ, Hopewell S. Patient-reported outcome measures following revision knee replacement: a review of PROM instrument utilisation and measurement properties using the COSMIN checklist. BMJ Open 2021; 11:e046169. [PMID: 34675009 PMCID: PMC8532560 DOI: 10.1136/bmjopen-2020-046169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To identify: (1) patient-reported outcome measures (PROMs) used to evaluate symptoms, health status or quality of life following discretionary revision (or re-revision) knee joint replacement, and (2) validated joint-specific PROMs, their measurement properties and quality of evidence. DESIGN (1) Scoping review; (2) systematic review following the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. DATA SOURCES MEDLINE, Embase, AMED and PsycINFO were searched from inception to 1 July 2020 using the Oxford PROM filter unlimited by publication date or language. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting on the development, validation or outcome of a joint-specific PROM for revision knee joint replacement were included. RESULTS 51 studies reported PROM outcomes using eight joint-specific PROMs. 27 out of 51 studies (52.9%) were published within the last 5 years. PROM development was rated 'inadequate' for each of the eight PROMs studied. Validation studies were available for only three joint-specific PROMs: Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). 25 out of 27 (92.6%) measurement properties were rated insufficient, indeterminate or not assessed. The quality of supporting evidence was mostly low or very low. Each of the validated PROMs was rated 'B' (potential for recommendation but require further evaluation). CONCLUSION Joint-specific PROMs are increasingly used to report outcomes following revision knee joint replacement, but these instruments have insufficient evidence for their validity. Future research should be directed toward understanding the measurement properties of these instruments in order to inform clinical trials and observational studies evaluating the outcomes from joint-specific PROMs.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth A Hedge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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12
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Wilson RA, Gwynne-Jones DP, Sullivan TA, Abbott JH. Total Hip and Knee Arthroplasties Are Highly Cost-Effective Procedures: The Importance of Duration of Follow-Up. J Arthroplasty 2021; 36:1864-1872.e10. [PMID: 33589278 DOI: 10.1016/j.arth.2021.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/21/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip and knee arthroplasties (THA/TKA) are clinically effective but high cost procedures. The aim of this study is to perform a cost-effectiveness analysis of THA and TKA in the New Zealand (NZ) healthcare system. METHODS Data were collected from 713 patients undergoing THA and 520 patients undergoing TKA at our local public hospital. SF-6D utility values were obtained from participants preoperatively and 1-year postoperatively, and deaths and any revision surgeries from patient records and the New Zealand Joint Registry at minimum 8-year follow-up. A continuous-time state-transition simulation model was used to estimate costs and health gains to 15 years. Quality-adjusted life years (QALYs), treatment costs, and incremental cost-effectiveness ratios (ICERs) were calculated to determine cost effectiveness. ICERs below NZ gross domestic product (GDP; NZ$60 600) and 0.5 times GDP per capita were considered "cost effective" and "highly cost effective" respectively. RESULTS Cumulative health gains were 2.8 QALYs (THA) and 2.3 QALYs (TKA) over 15 years. Cost effectiveness improved from ICERs of NZ$74,400 (THA) and NZ$93,000 (TKA) at 1 year to NZ$6000 (THA) and NZ$7500 (TKA) at 15 years. THA and TKA were cost effective after 2 years and highly cost effective after 3 years. QALY gains and cost effectiveness were greater in patients with worse preoperative functional status and younger age. CONCLUSION THA and TKA are highly cost-effective procedures over longer term horizons. Although preoperative status and age were associated with cost effectiveness, both THA and TKA remained cost effective in patients with less severe preoperative scores and older ages.
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Affiliation(s)
- Ross A Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - David P Gwynne-Jones
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand; Department of Orthopaedics, Dunedin Hospital, Dunedin, New Zealand
| | - Trudy A Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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13
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Sabah SA, Alvand A, Beard DJ, Price AJ. Evidence for the validity of a patient-based instrument for assessment of outcome after revision knee arthroplasty. Bone Joint J 2021; 103-B:627-634. [PMID: 33789485 DOI: 10.1302/0301-620x.103b4.bjj-2020-1560.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS To estimate the measurement properties for the Oxford Knee Score (OKS) in patients undergoing revision knee arthroplasty (responsiveness, minimal detectable change (MDC-90), minimal important change (MIC), minimal important difference (MID), internal consistency, construct validity, and interpretability). METHODS Secondary data analysis was performed for 10,727 patients undergoing revision knee arthroplasty between 2013 to 2019 using a UK national patient-reported outcome measure (PROM) dataset. Outcome data were collected before revision and at six months postoperatively, using the OKS and EuroQol five-dimension score (EQ-5D). Measurement properties were assessed according to COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) guidelines. RESULTS A total of 9,219 patients had complete outcome data. Mean preoperative OKS was 16.7 points (SD 8.1), mean postoperative OKS 29.1 (SD 11.4), and mean change in OKS + 12.5 (SD 10.7). Median preoperative EQ-5D index was 0.260 (interquartile range (IQR) 0.055 to 0.691), median postoperative EQ-5D index 0.691 (IQR 0.516 to 0.796), and median change in EQ-5D index + 0.240 (IQR 0.000 to 0.567). Internal consistency was good with Cronbach's α 0.88 (baseline) and 0.94 (post-revision). Construct validity found a high correlation of OKS total score with EQ-5D index (r = 0.76 (baseline), r = 0.83 (post-revision), p < 0.001). The OKS was responsive with standardized effect size (SES) 1.54 (95% confidence interval (CI) 1.51 to 1.57), compared to SES 0.83 (0.81 to 0.86) for the EQ-5D index. The MIC for the OKS was 7.5 points (95% CI 5.5 to 8.5) based on the optimal cut-off with specificity 0.72, sensitivity 0.60, and area under the curve 0.66. The MID for the OKS was 5.2 points. The MDC-90 was 3.9 points. The OKS did not demonstrate significant floor or ceiling effects. CONCLUSION This study found that the OKS was a useful and valid instrument for assessment of outcome following revision knee arthroplasty. The OKS was responsive to change and demonstrated good measurement properties. Cite this article: Bone Joint J 2021;103-B(4):627-634.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford, UK
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14
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Santana-Pineda MM, Vanlinthout LE, Santana-Ramírez S, Vanneste T, Van Zundert J, Novalbos-Ruiz JP. A Randomized Controlled Trial to Compare Analgesia and Functional Improvement After Continuous Neuroablative and Pulsed Neuromodulative Radiofrequency Treatment of the Genicular Nerves in Patients with Knee Osteoarthritis up to One Year After the Intervention. PAIN MEDICINE 2021; 22:637-652. [PMID: 33179073 DOI: 10.1093/pm/pnaa309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the analgesic and functional outcomes of continuous neuroablative radiofrequency (CNARF) and pulsed neuromodulative radiofrequency (PNMRF) treatment of genicular nerves up to 1 year after the intervention and to identify predictors associated with a successful outcome (defined as an at least 50% reduction in the pre-interventional visual analog scale [VAS] rating) after genicular radiofrequency treatment. DESIGN A prospective randomized controlled trial. SETTING The Pain Department of the Jerez de la Frontera University Hospital, Cadíz, Spain, from January 2018 until May 2019. SUBJECTS Patients with grade 3-4 gonarthritis suffering from knee pain, with a VAS score ≥5 for >6 months. METHODS Eligible participants were randomly assigned to receive either CNARF or PNMRF of the superior medial, superior lateral, and inferior medial genicular nerves. The VAS and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before and at 1, 6, and 12 months after treatment. Medication use was quantified before and at 6 months after the intervention. Potential characteristics associated with the efficacy of radiofrequency intervention were explored by using multivariable statistical models. RESULTS A total of 188 participants were included. The magnitude and duration of beneficial effect and reduction in analgesic use were significantly greater in the CNARF group. Success at 6 months after radiofrequency treatment decreased with grade 4 gonarthritis; higher pre-interventional VAS score; and concomitant depression, anxiety disorder, and diabetes mellitus. CONCLUSIONS Therapeutic efficacy and reduction in analgesic consumption were superior after CNARF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.
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Affiliation(s)
- María M Santana-Pineda
- Department of Anesthesiology and Pain Medicine, University Hospital Campus Jerez de la Frontera, University of Cadíz, Cadíz, Spain
| | - Luc E Vanlinthout
- Department of Anesthesiology and Pain Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.,Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Universities of Leuven and Hasselt, Leuven and Diepenbeek, Belgium
| | - Samuel Santana-Ramírez
- Department of Orthopedics and Traumatology, University Hospital Campus Jerez de la Frontera, University of Cadíz, Cadíz, Spain
| | - Thibaut Vanneste
- Multidisciplinary Pain Centre at the Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.,Multidisciplinary Pain Centre at the Ziekenhuis Oost-Limburg , Genk, Belgium
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15
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Sabah SA, Alvand A, Price AJ. Revision knee replacement for prosthetic joint infection: Epidemiology, clinical outcomes and health-economic considerations. Knee 2021; 28:417-421. [PMID: 33500184 DOI: 10.1016/j.knee.2020.12.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
Prosthetic joint infection (PJI) is a devastating complication of knee replacement surgery. Recent evidence has shown that the burden of disease is increasing as more and more knee replacement procedures are performed. The current incidence of revision total knee replacement (TKR) for PJI is estimated at 7.5 cases per 1000 primary joint replacement procedures at 10 years. Revision TKR for PJI is complex surgery, and is associated to a high rate of post-operative complications. The 5-year patient mortality is comparable to some common cancer diagnoses, and more than 15% of patients require re-revision by 10 years. Patient-reported outcome measures (PROMs) including joint function may be worse following revision TKR for PJI than for aseptic indications. The complexity and extended length of the treatment pathway for PJI places a significant burden on the healthcare system, highlighting it as an area for future research to identify the most clinically and cost-effective interventions.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX2 9JA, UK
| | - Abtin Alvand
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX2 9JA, UK
| | - Andrew J Price
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX2 9JA, UK.
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16
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Weick JW, Bullard J, Green JH, Gagnier JJ. Measures of Hip Function and Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:200-218. [PMID: 33091262 DOI: 10.1002/acr.24231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
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17
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Leal J, Murphy J, Garriga C, Delmestri A, Rangan A, Price A, Carr A, Prieto-Alhambra D, Judge A. Costs of joint replacement in osteoarthritis: a study using the National Joint Registry and Clinical Practice Research Datalink datasets. Arthritis Care Res (Hoboken) 2020; 74:392-402. [PMID: 33002322 DOI: 10.1002/acr.24470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the costs of primary hip and knee replacement in individuals with osteoarthritis up to 2 years post-surgery, compare costs before and after the surgery, and identify predictors of hospital costs. METHODS Patients aged 18 years or over with primary planned hip or knee replacements and osteoarthritis in England between 2008 and 2016 were identified from the National Joint Registry and linked with Hospital Episode Statistics data containing inpatient episodes. Primary care data linked with hospital outpatient records were also used to identify patients aged 18 years or over with primary hip or knee replacements between 2008 and 2016. All healthcare resource use was valued using 2016/17 costs and non-parametric censoring methods were used to estimate total 1-year and 2-year costs. RESULTS We identified 854,866 individuals undergoing hip or knee replacement. The mean censor-adjusted 1-year hospitalisation costs for hip and knee replacement were £7,827 (95% CI £7,813 to £7,842) and £7,805 (95% CI £7,790 to £7,818), respectively. Complications and revisions were associated with up to a three-fold increase in 1-year hospitalisation costs. The censor-adjusted 2-year costs were £9,258 (95 % CI £9,233 to £9,280) and £9,452 (95%CI £9,430 to £9,475) for hip and knee replacement. Adding primary and outpatient care, the mean total hip and knee replacement 2-year costs were £11,987 and £12,578, respectively. CONCLUSIONS There are significant costs following joint replacement. Revisions and complications accounted for considerable costs and there is a significant incentive to identify best approaches to reduce these.
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Affiliation(s)
- Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Jacqueline Murphy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Cesar Garriga
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland.,National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland.,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland.,Musculoskeletal Research Unit, University of Bristol
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18
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Psychometric Evaluation of Patient-reported Outcomes Measurement Information System Physical Function Computer Adaptive Testing in Minimally Invasive Lumbar Spine Surgery: An Analysis of Responsiveness, Coverage, Discriminant Validity, and Concurrent Validity. J Am Acad Orthop Surg 2020; 28:717-729. [PMID: 32833390 DOI: 10.5435/jaaos-d-19-00306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although the Patient-reported Outcomes Measurement Information System (PROMIS) is increasingly being used, there are few studies assessing the psychometric properties of PROMIS in minimally invasive spine (MIS) surgery. Thus, the purpose of this study was to perform a psychometric evaluation of PROMIS Physical Function Computer Adaptive Testing (PROMIS-PF CAT) in MIS lumbar surgery. METHODS The patient-reported outcome measures collected preoperatively and postoperatively of patients undergoing MIS lumbar surgery were retrospectively analyzed to assess responsiveness, coverage, discriminant validity, and concurrent validity of PROMIS-PF CAT. RESULTS Four hundred twenty-one patients were included. The responsiveness of PROMIS Physical Function (PROMIS-PF) was lower than that of the Oswestry Disability Index (ODI) in the decompression subgroup. Although the ODI had a ceiling effect of 16.7% at 1 year, the Short-Form 12 physical health score and PROMIS-PF did not show floor or ceiling effects. PROMIS-PF demonstrated discriminant validity preoperatively and postoperatively and convergent validity with the ODI, as evidenced by a significant strong negative correlation but not with the Short-Form 12 Physical Health Score, as evidenced by the variability in strength of correlation. CONCLUSIONS Although the PROMIS-PF showed lower responsiveness than the ODI, particularly in the decompression subgroup, it demonstrated discriminant validity preoperatively and postoperatively, convergent validity with ODI, and better coverage than ODI. These findings suggest that the PROMIS-PF CAT demonstrates reasonable psychometric properties and may be a good surrogate for the ODI.
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19
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Price AJ, Kang S, Cook JA, Dakin H, Blom A, Arden N, Fitzpatrick R, Beard DJ. The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty. Bone Joint J 2020; 102-B:941-949. [PMID: 32600142 DOI: 10.1302/0301-620x.102b7.bjj-2019-0102.r2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To calculate how the likelihood of obtaining measurable benefit from hip or knee arthroplasty varies with preoperative patient-reported scores. METHODS Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual's probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). A clinically meaningful improvement after arthroplasty was defined as ≥ 8 point improvement in OHS, and ≥ 7 in OKS. RESULTS The upper preoperative score threshold, above which patients are unlikely to achieve any meaningful improvement from surgery, is 41 for knees and 40 for hips. At lower scores, the probability of improvement increased towards a maximum of 88% (knee) and 95% for (hips). CONCLUSION By our definition of meaningful improvement, patients with preoperative scores above 41 (OKS) and 40 (OHS) should not be routinely referred to secondary care for possible arthroplasty. Using lower thresholds would incrementally increase the probability of meaningful benefit for those referred but will exclude some patients with potential to benefit. The findings are useful to support the complex shared decision-making process in primary care for referral to secondary care; and in secondary care for experienced clinicians counselling patients considering knee or hip arthroplasty, but should not be used in isolation. Cite this article: Bone Joint J 2020;102-B(7):941-949.
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Affiliation(s)
- Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Sujin Kang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Helen Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Ashley Blom
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
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20
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Dakin H, Eibich P, Beard D, Gray A, Price A. The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty. Bone Joint J 2020; 102-B:950-958. [PMID: 32600136 DOI: 10.1302/0301-620x.102b7.bjj-2019-0105.r2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. METHODS We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. RESULTS THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. CONCLUSION If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950-958.
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Affiliation(s)
- H Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P Eibich
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - D Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, NIHR Biomedical Research Unit, University of Oxford, Oxford, UK
| | - A Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, NIHR Biomedical Research Unit, University of Oxford, Oxford, UK
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21
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Gwynne-Jones DP, Sullivan T, Wilson R, Abbott JH. The Relationship Between Preoperative Oxford Hip and Knee Score and Change in Health-Related Quality of Life After Total Hip and Total Knee Arthroplasty: Can It Help Inform Rationing Decisions? Arthroplast Today 2020; 6:585-589.e1. [PMID: 32995405 PMCID: PMC7502579 DOI: 10.1016/j.artd.2020.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/02/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background In countries with publicly funded health care, there is an increasing need for explicit rationing for total joint arthroplasty (TJA). The Oxford Hip and Knee Scores (OHS/OKS) have been used to set access thresholds for TJA despite not being developed for that purpose. The aim of this study was to determine whether preoperative OHS/OKS can aid rationing decisions by investigating the changes in general health-related quality of life after TJA. Methods OHS/OKS, Short Form-12, and Short Form-6D (SF-6D) scores were collected preoperatively and at 1 year postoperatively in a cohort of patients undergoing total hip arthroplasty (THA; n = 713) and total knee arthroplasty (TKA; n = 520). The association between preoperative OHS/OKS and postoperative score and the change in OHS/OKS and SF-6D was investigated, adjusting for age and gender. Results The mean Oxford scores improved from 13.9 to 40.7 (OHS) and 15.6 to 37.4 (OKS). The mean SF-6D improved after THA (0.53 to 0.80) and TKA (0.56 to 0.78) (all P < .0001). Poorer preoperative Oxford scores were associated with poorer postoperative OHS/OKS and SF-6D but larger improvements. For every 5 points lower preoperative OHS/OKS, the postoperative SF-6D score was worse by a margin of 0.019 (THA) and 0.023 (TKA). Conclusions Preoperative OHS/OKS can help inform rationing decisions. A lower preoperative OHS/OKS will result in greater gains but a lower final outcome score in general health-related quality of life.
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Affiliation(s)
- David P Gwynne-Jones
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | | | - Ross Wilson
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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22
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Vaishnav AS, Gang CH, Iyer S, McAnany S, Albert T, Qureshi SA. Correlation between NDI, PROMIS and SF-12 in cervical spine surgery. Spine J 2020; 20:409-416. [PMID: 31678044 DOI: 10.1016/j.spinee.2019.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As the focus in spine surgery has shifted from radiographic to patient-centric outcome, patient-reported outcomes measures (PROMs) are becoming increasingly important. They are linked to patient satisfaction, and are used to assess healthcare expenditure, determine compensation and evaluate cost-effectiveness. Thus, PROMs are important to various stakeholders, including patients, physicians, payers, and healthcare institutions. Thus, it is vital to establish methods to interpret and evaluate these outcome measures. PURPOSE To evaluate the correlation between Neck Disability Index (NDI), Patient Reported Outcome Measurement Information System Physical Function (PROMIS-PF) and Short Form-12 Physical Health Score (SF-12 PHS) in cervical spinal surgery in order to determine the validity of PROMIS-PF in these patients. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Consecutive patients who underwent cervical surgery for degenerative spinal pathology with a minimum of 3 months follow-up. OUTCOME MEASURES Self-reported measures that is, PROMs including NDI, PROMIS-PF, and SF-12 PHS. METHODS No funding was received for this study. The authors report no relevant conflict of interest. PROM collected preoperatively and at each follow-up were analyzed using Pearson product-moment correlation. RESULTS Of the 121 patients included, 66 underwent anterior cervical discectomy and fusion, 42 cervical disc replacement, 13 posterior cervical decompression with or without fusion. A statistically significant improvement was achieved in all PROMs by 6 weeks and maintained at 1 year. Furthermore, the percentage of patients achieving an improvement greater than minimum clinically important difference was similar for NDI and PROMIS-PF, particularly at a follow-up of 3 months or more. A statistically significant negative correlation was seen between NDI and PROMIS-PF, which was moderate preoperatively and in the early postoperative period (r=-0.565 to -0.600), and strong at 3 months or longer follow-up (r=-0.622 to -0.705). A statistically significant, negative correlation was also seen between SF-12 PHS and NDI, which was moderate preoperatively and at 6 weeks (r=-0.5551 to -0.566); and strong at all other time-points (r=-0.678 to -0.749). There was a statistically significant positive correlation between SF-12 PHS and PROMIS-PF, which was strong to very-strong at all time-points (r=0.644-0.822), except at 2 weeks (r=0.570). CONCLUSIONS Although NDI and SF-12 have been used for several years, PROMIS is a new outcome measure that is increasingly being implemented. The results of our study demonstrate the convergent and discriminant validity of PROMIS-PF, supported by the strong correlation between SF-12 PHS and PROMIS-PF at all time-points and the moderate correlation between NDI and PROMIS-PF preoperatively and in the early postoperative period, respectively. Thus, while PROMIS-PF may not be a good surrogate for disease-specific outcome measures, it may extend value as a precise and efficient general health tool.
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Affiliation(s)
| | | | - Sravisht Iyer
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Steven McAnany
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA.
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23
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Judge A, Carr A, Price A, Garriga C, Cooper C, Prieto-Alhambra D, Old F, Peat G, Murphy J, Leal J, Barker K, Underdown L, Arden N, Gooberman-Hill R, Fitzpatrick R, Drew S, Pritchard MG. The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is limited evidence concerning the effectiveness of enhanced recovery programmes in hip and knee replacement surgery, particularly when applied nationwide across a health-care system.
Objectives
To determine the effect of hospital organisation, surgical factors and the enhanced recovery after surgery pathway on patient outcomes and NHS costs of hip and knee replacement.
Design
(1) Statistical analysis of national linked data to explore geographical variations in patient outcomes of surgery. (2) A natural experimental study to determine clinical effectiveness of enhanced recovery after surgery. (3) A qualitative study to identify barriers to, and facilitators of, change. (4) Health economics analysis to establish NHS costs and cost-effectiveness.
Setting
Data from the National Joint Registry, linked to English Hospital Episode Statistics and patient-reported outcome measures in both the geographical variation and natural experiment studies, together with the economic evaluation. The ethnographic study took place in four hospitals in a region of England.
Participants
Qualitative study – 38 health professionals working in hip and knee replacement services in secondary care and 37 patients receiving hip or knee replacement.
Interventions
Natural experiment – implementation of enhanced recovery after surgery at each hospital between 2009 and 2011. Enhanced recovery after surgery is a complex intervention focusing on several areas of patients’ care pathways through surgery: preoperatively (patient is in best possible condition for surgery), perioperatively (patient has best possible management during and after operation) and postoperatively (patient experiences best rehabilitation).
Main outcome measures
Patient-reported pain and function (Oxford Hip Score/Oxford Knee Score); 6-month complications; length of stay; bed-day costs; and revision surgery within 5 years.
Results
Geographical study – there are potentially unwarranted variations in patient outcomes of hip and knee replacement surgery. This variation cannot be explained by differences in patients, case mix, surgical or hospital organisational factors. Qualitative – successful implementation depends on empowering patients to work towards their recovery, providing post-discharge support and promoting successful multidisciplinary team working. Care processes were negotiated between patients and health-care professionals. ‘Good care’ remains an aspiration, particularly in the post-discharge period. Natural experiment – length of stay has declined substantially, pain and function have improved, revision rates are in decline and complication rates remain stable. The introduction of a national enhanced recovery after surgery programme maintained improvement, but did not alter the rate of change already under way. Health economics – costs are high in the year of joint replacement and remain higher in the subsequent year after surgery. There is a strong economic incentive to identify ways of reducing revisions and complications following joint replacement. Published cost-effectiveness evidence supports enhanced recovery pathways as a whole.
Limitations
Short duration of follow-up data prior to enhanced recovery after surgery implementation and missing data, particularly for hospital organisation factors.
Conclusion
No evidence was found to show that enhanced recovery after surgery had a substantial impact on longer-term downwards trends in costs and length of stay. Trends of improving outcomes were seen across all age groups, in those with and without comorbidity, and had begun prior to the formal enhanced recovery after surgery roll-out. Reductions in length of stay have been achieved without adversely affecting patient outcomes, yet, substantial variation remains in outcomes between hospital trusts.
Future work
There is still work to be done to reduce and understand unwarranted variations in outcome between individual hospitals.
Study registration
This study is registered as PROSPERO CRD42017059473.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew Judge
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Andrew Carr
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cesar Garriga
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Prieto-Alhambra
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
- GREMPAL Research Group, Musculoskeletal Research Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jacqueline Murphy
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Barker
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lydia Underdown
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel Arden
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Rachael Gooberman-Hill
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sarah Drew
- National Institute for Health Research Bristol Biomedical Research Centre, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark G Pritchard
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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24
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Neufeld ME, Masri BA. Can the Oxford Knee and Hip Score identify patients who do not require total knee or hip arthroplasty? Bone Joint J 2019; 101-B:23-30. [DOI: 10.1302/0301-620x.101b6.bjj-2018-1460.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine if the Oxford Knee and Hip Score (OKHS) can accurately predict when a primary knee or hip referral is deemed nonsurgical versus surgical by the surgeon during their first consultation, and to identify nonsurgical OKHS screening thresholds. Patients and Methods We retrospectively reviewed pre-consultation OKHS for all consecutive primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) consultations of a single surgeon over three years. The 1436 knees (1016 patients) and 478 hips (388 patients) included were categorized based on the surgeon’s decision into those offered surgery during the first consultation versus those not (nonsurgical). Spearman’s rank correlation coefficients and receiver operating characteristic (ROC) curve analysis were performed. Results Oxford Scores were better for the nonsurgical cohorts (p < 0.001) and correlated with the surgical decision (p < 0.001). ROC area under the curve values for knees (0.83, 95% confidence intervals (CI) 0.81 to 0.85) and hips (0.87, 95% CI 0.84 to 0.91) were excellent. A conservative and effective threshold for knees is Oxford Knee Score (OKS) > 32 points (sensitivity = 0.997, negative predictive value (NPV) = 0.992) and for hips is Oxford Hip Score (OHS) > 34 points (sensitivity = 0.997, NPV = 0.978). Severable potential lower OKHS thresholds were identified. Conclusion Pre-consultation OKHS demonstrate good ability to predict when a primary TKA or THA referral will be deemed nonsurgical in a single surgeon’s practice. Multiple OKHS thresholds can effectively screen out nonsurgical referrals. Cite this article: Bone Joint J 2019;101-B(6 Supple B):23–30.
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Affiliation(s)
- M. E. Neufeld
- Department of Orthopaedics, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, Canada
| | - B. A. Masri
- Department of Orthopaedics, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, Canada
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25
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CORR Insights®: What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions? Clin Orthop Relat Res 2018; 476:2037-2039. [PMID: 30179965 PMCID: PMC6259815 DOI: 10.1097/corr.0000000000000465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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