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Palo N, Dey PC, Lakhanpal M, Shukla A, Choudhary GN, Singh A, Kumar GR, Malik C. Funding Pattern Comparison Pre- and Post-Ayushman Bharat National Health Scheme (AB-PMJAY) in Active Females Undergoing TKA for Advanced Knee Arthritis with Clinical, QoL Analysis and AB-PMJAY Technical Data. Indian J Orthop 2024; 58:550-557. [PMID: 38694691 PMCID: PMC11058124 DOI: 10.1007/s43465-024-01136-0] [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: 12/20/2023] [Accepted: 03/17/2024] [Indexed: 05/04/2024]
Abstract
Introduction Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. Methods A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. Results 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Conclusion Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.
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Affiliation(s)
- Nishit Palo
- Department of Orthopedics, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh India
| | - Paresh Chandra Dey
- Department of Orthopaedics, Kaling Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Mahima Lakhanpal
- Department of Anaesthesiology & Critical Care, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh India
| | - Abhishek Shukla
- Department of Orthopedics, Holy Family Hospital, Delhi, India
| | | | - Aditya Singh
- Santosh Medical College & Hospital, Ghaziabad, India
| | | | - Chhavi Malik
- Department of Pharmacology, SHKM Government Medical College, Nuh, Haryana India
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Lor M, Xiong S, Yang NB, Koleck TA. Systematic Review of Pain Research Among Limited English Proficiency Patient Populations in Health care. Pain Manag Nurs 2024; 25:160-169. [PMID: 38104018 DOI: 10.1016/j.pmn.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Pain remains a global health problem affecting all populations. There is limited knowledge, however, about the effect of limited English proficiency (LEP) on pain care and outcomes. AIM This systematic review determines the current state of pain research for LEP populations. METHOD We searched peer-reviewed studies in PubMed, CINAHL, PsychInfo, and Google Scholar from 1970 to 2021. Two authors independently screened abstracts and full texts, evaluated the quality of the studies using the Mixed Methods Appraisal Tool, and extracted study characteristics, content, and findings into Microsoft Excel. RESULTS Twenty-five studies met our inclusion criteria. Of the 25 articles, 15 were quantitative, three were mixed methods, five were qualitative, one was quasi-experimental, and one was a randomized controlled trial. Four studies addressed all items of the Mixed Methods Appraisal Tool. Most pain research among patients with LEP was conducted in the United States (n = 17) and in hospital settings (n = 16). The majority of studies focused on one language (n = 15) with Spanish (n = 8) being the most studied language. Sample sizes ranged from seven to 18,593. Studies focused on three main themes: pain communication (n = 14), pain management (n =5) and/or outcomes (n = 1), and pain prevalence (n = 3). CONCLUSIONS The findings revealed that the pain research on LEP populations is still in its infancy, with varied areas of focus using descriptive research designs. More pain intervention research for LEP populations is needed to reduce pain disparities.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin.
| | - Shoua Xiong
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Nancy B Yang
- University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Theresa A Koleck
- University of Pittsburg, School of Nursing, Pittsburgh, Pennsylvania
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Dubin JA, Bains SS, Hameed D, Monárrez R, Moore MC, Mont MA, Nace J, Delanois RE. The Utility of the Social Vulnerability Index as a Proxy for Social Disparities Following Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00074-3. [PMID: 38325529 DOI: 10.1016/j.arth.2024.01.049] [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: 10/31/2023] [Revised: 12/18/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In 2021, alternative payment models accounted for 40% of traditional Medicare reimbursements. As such, we sought to examine health disparities through a standardized categorization of social disparity using the social vulnerability index (SVI). We examined (1) risk factors for SVI ≥ 0.50, (2) incidences of complications, and (3) risk factors for total complications between patients who have SVI < 0.50 and SVI ≥ 0.50 who had a total knee arthroplasty (TKA). METHODS Patients who underwent TKA between January 1, 2022 and December 31, 2022 were identified in the state of Maryland. A total of 4,952 patients who had complete social determinants of health data were included. Patients were divided into 2 cohorts according to SVI: < 0.50 (n = 2,431) and ≥ 0.50 (n = 2,521) based on the national mean SVI of 0.50. The SVI identifies communities that may need support caused by external stresses on human health based on 4 themed scores: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. The SVI theme of household composition and disability encompassed patients aged 65 years and more, patients aged 17 years and less, civilians who have a disability, single-parent households, and English language deficiencies. The higher the SVI, the more social vulnerability or resources are needed to thrive in a geographic area. RESULTS When controlling for risk factors and patient comorbidities, the theme of household composition and disability (odds ratio 2.0, 95% confidence interval 1.1 to 5.0, P = .03) was the only independent risk factor for total complications. Patients who had an SVI ≥0.50 were more likely to be women (65.8% versus 61.0%, P < .001), Black (34.4% versus 12.9%, P < .001), and have a median household income < $87,999 (21.3% versus 10.2%, P < .001) in comparison to the patients who had an SVI < 0.50, respectively. CONCLUSIONS The SVI theme of household composition and disability, encompassing patients aged 65 years and more, patients aged 17 years and less, civilians who have a disability, single-parent households, and English language deficiencies, were independent risk factors for total complications following TKA. Together, these findings offer opportunities for interventions with selected patients to address social disparities.
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Affiliation(s)
- Jeremy A Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Rubén Monárrez
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Mallory C Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Bonsel JM, Reijman M, Verhaar JAN, van Steenbergen LN, Janssen MF, Bonsel GJ. Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis. Osteoarthritis Cartilage 2024; 32:200-209. [PMID: 37482250 DOI: 10.1016/j.joca.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. METHODS We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. RESULTS Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D -0.03 (95%CI -0.02, -0.04), OHS -1.26 (-0.99, -1.52)) and 12-month follow-up health (EQ-5D -0.02 (-0.01, -0.02), OHS -0.42 (-0.19, -0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. CONCLUSION The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).
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Affiliation(s)
- Joshua M Bonsel
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), the Netherlands.
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, the Netherlands.
| | - Gouke J Bonsel
- EuroQol Research Foundation, Rotterdam, the Netherlands.
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Rajahraman V, Lawrence KW, Berzolla E, Lajam CM, Schwarzkopf R, Rozell JC. The Benefit in Patient-Reported Outcomes After Total Knee Arthroplasty was Comparable Across Income Quartiles. J Arthroplasty 2023; 38:1652-1657. [PMID: 36963532 DOI: 10.1016/j.arth.2023.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Few studies have assessed how socioeconomic status (SES) influences patient-reported outcomes (PROMs) after total knee arthroplasty (TKA). This study evaluated the impact of patient median ZIP code income levels on PROMs after TKA. METHODS We retrospectively reviewed patients at our institution undergoing primary, unilateral TKA from 2017 to 2020. Patients who did not have one-year postoperative PROMs were excluded. Patients were stratified based on the quartile of their home ZIP code median income from United States Census Bureau data. There were 1,267 patients included: 98 in quartile 1 (median income ≤ $46,308) (7.7%); 126 in quartile 2 (median income $46,309-$57,848) (10.0%); 194 in quartile 3 (median income $57,849-$74,011) (15.7%); and 849 in quartile 4 (median income ≥ $74,012) (66.4%). We collected baseline demographic data, 2-year outcomes, and PROMs preoperatively, as well as at 12 weeks and one year, postoperatively. RESULTS The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was significantly higher in quartile 4 preoperatively (P < .001), 12 weeks postoperatively (P < .001), and one year postoperatively (P < .001). There were no significant differences in delta improvements of Knee Injury and Osteoarthritis Outcome Score for Joint Replacement from preoperative to 12 weeks or one year postoperatively. There were no significant differences in lengths of stay, discharge dispositions, readmissions, or revisions. CONCLUSION Patients from lower income areas have slightly worse knee function preoperatively and worse outcomes following TKA. However, improvements in PROMs throughout the first year postoperatively are similar across income quartiles, suggesting that patients from lower income quartiles achieve comparable therapeutic benefits from TKA. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vinaya Rajahraman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Emily Berzolla
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional outcomes following knee replacement in community-dwelling older adults. BMC Geriatr 2023; 23:261. [PMID: 37131170 PMCID: PMC10152584 DOI: 10.1186/s12877-023-03925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Knee replacements are increasingly performed in older adults but uncertainty remains regarding their benefits in the context of age-related decline in physical function and other comorbidities. This study aimed to examine (1) the effect of knee replacement on functional outcomes in the context of age-related decline in physical function and (2) the factors associated with minimal important improvement in physical function after knee replacement in community-dwelling older adults aged ≥ 70 years. METHODS This cohort study was performed within the ASPREE trial, with 889 participants undergoing knee replacement during the trial and 858 age- and sex-matched controls without knee or hip replacement identified from 16,703 Australian participants aged ≥ 70 years. Health-related quality of life was assessed annually using the SF-12, including its physical and mental component summary (PCS and MCS). Gait speed was measured biennially. Multiple linear regression and analysis of covariance were used to adjust for potential confounders. RESULTS Participants with knee replacement had significantly lower pre- and post-replacement PCS scores and gait speed compared with age- and sex-matched controls. Participants with knee replacement had significant improvement in PCS score following knee replacement (mean change 3.6, 95% CI 2.9-4.3) while PCS score remaining unchanged in age- and sex-matched controls (-0.02, 95% CI -0.6 to 0.6) during follow-up period. The greatest improvements were observed for bodily pain and physical function. Following knee replacement, 53% of participants experienced minimal important improvement in PCS score (increased by ≥ 2.7), while 24% experienced worsened PCS score (reduced by > 2.7). Participants experiencing improved PCS score postoperatively had significantly lower PCS and higher MCS scores pre-surgery. CONCLUSIONS Although community-based older adults experienced a significant improvement in PCS scores after knee replacement, their postoperative physical functional status remained significantly lower than age- and sex-matched controls. The degree of preoperative physical function impairment was a strong predictor of functional improvement, suggesting that this could be an important consideration when identifying older people most likely to benefit from knee replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Ayers DC, Yousef M, Yang W, Zheng H. Age-Related Differences in Pain, Function, and Quality of Life Following Primary Total Knee Arthroplasty: Results from a FORCE-TJR Cohort. J Arthroplasty 2023:S0883-5403(23)00350-9. [PMID: 37121490 DOI: 10.1016/j.arth.2023.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION The impact of age on patient outcomes after total knee arthroplasty (TKA) remains controversial. Age has shown no effect on outcome in some studies, while others have reported better or worse outcome in younger patients. The aims of this study were to determine the differences in pain, function, and quality of life reported one-year after TKA across different age groups. METHODS A prospective, multi-center cohort of 11,602 unilateral primary TKA patients was evaluated. Demographic data, comorbid conditions, and patient-reported outcome measures (PROMs) including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS JR, and Short-Form health survey (12-item) were collected pre- and at one-year postoperatively. Descriptive statistics were generated, stratified by age [< 55 years (younger adult), 55 to 64 years (older adult), 65 to 74 years (early elder), and ≥ 75 years (late elder)], and differences in pain, function, and quality of life among the four age groups were evaluated using Chi-square and Kruskal-Wallis tests. Multivariate regression models with 95% confidence interval (CI) were performed to determine if age was predictive for KOOS pain and function scores. RESULTS Prior to surgery, younger patients (< 55 years) reported worse KOOS pain (39), function (50), and quality of life (18) scores with poor mental health score (47) than other older patient groups. The mean pre-op score differences across the age groups in the KOOS total score (9.37), KOOS pain (11.61), KOOS-12 pain (10.14), and KOOS/KOOS-12 QoL (12.60) reached the calculated minimal clinically important difference (MCID). At one-year after TKA, younger patients (< 55 years) reported lower KOOS pain, function, and quality of life scores when compared to older patients (≥ 75 years). The differences in one-year postop scores among the 4 age groups (ranging from 4.0 to 12.2) reached the MCID for pain (10.4) and quality of life (12.2). Younger patients (< 55 years) achieved higher baseline to one-year pain (36.8 points), function (30.3 points), and quality of life (40.7 points) score changes when compared to older patients ≥ 75 years. Although statistically significant, the differences in score changes among the age groups were clinically irrelevant. The multivariate regression analyses showed that age was a significant predictor for pain, but not for function at one year where KOOS pain score was predicted to be higher (less pain) (β =6.17; 95% CI (4.12- 8.22) (P<0.001) in older patients (≥ 75 years) when compared to younger patients (< 55 years). CONCLUSION A TKA provides a dramatic improvement in pain, function, and quality of life in all age groups. However, there are age-related clinically significant differences in pre-operative pain, quality of life, and mental health and in final post-operative pain and quality of life scores with younger patients (< 55 years) reporting more pain, less quality of life, and worse pre-operative mental health. The PROM data presented here can be used clinically to improve shared decision making and patient expectations prior to TKA.
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Affiliation(s)
- David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Mohamed Yousef
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
| | - Wenyun Yang
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Zhang B, Rao S, Mekkawy KL, Rahman R, Sarfraz A, Hollifield L, Runge N, Oni JK. Risk factors for pain after total hip arthroplasty: a systematic review. ARTHROPLASTY 2023; 5:19. [PMID: 37009894 PMCID: PMC10069042 DOI: 10.1186/s42836-023-00172-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Approximately 23% of patients develop hip pain after total hip arthroplasty (THA). In this systematic review, we aimed to identify risk factors associated with postoperative pain after THA to optimize preoperative surgical planning. METHODS Six literature databases were searched for articles published from January 1995 to August 2020. Controlled trials and observational studies that reported measurements of postoperative pain with assessments of preoperative modifiable and non-modifiable risk factors were included. Three researchers performed a literature review independently. RESULTS Fifty-four studies were included in the study for analysis. The most consistent association between worse pain outcomes and the female sex is poor preoperative pain or function, and more severe medical or psychiatric comorbidities. The correlation was less strong between worse pain outcomes and preoperative high body mass index value, low radiographic grade arthritis, and low socioeconomic status. A weak correlation was found between age and worse pain outcomes. CONCLUSIONS Preoperative risk factors that were consistently predictive of greater/server postoperative pain after THA were identified, despite the varying quality of studies that prohibited the arrival of concrete conclusions. Modifiable factors should be optimized preoperatively, whereas non-modifiable factors may be valuable to patient education, shared decision-making, and individualized pain management.
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Affiliation(s)
- Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Sandesh Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Rafa Rahman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Anzar Sarfraz
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Lauren Hollifield
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Nick Runge
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Rubio-Morales M, Miralles-Muñoz FA, Gonzalez-Parreño S, Ruiz-Lozano M, Lizaur-Utrilla A, Vizcaya-Moreno MF. A relevant number of patients do not increase their engagement in physical, social and leisure activities at the medium-term after total knee arthroplasty: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:1011-1017. [PMID: 36114843 DOI: 10.1007/s00167-022-07165-2] [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: 07/09/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the changes in engagement in physical, leisure and social activities in older adults following primary TKA. METHODS A prospective study of 106 patients with a mean age of 72.6 (SD 7.4) years undergoing primary TKA was performed. Physical, social and leisure activities performed by the patients preoperatively and postoperatively at 3-year were recorded. Activities were selected according to the age, and grouped as passive, moderate and high intensity. The energy spent in each activity was expressed in Metabolic Equivalent of Task (MET) units. Charlson Comorbidity Index, Mini-mental test and Western Ontario and McMaster Universities (WOMAC) scores were also used. Multivariate analysis was used to identify predictors of active patients. RESULTS Mean WOMAC significantly improved from preoperative (34.8, SD 11.8) to final follow-up (74.4, SD 11.1) (p = 0.001), and the mean energy spent increased from 10.7 (SD 13.6) to 28.2 (SD 16.2) MET-hour weekly (p = 0.001) with a decrease in the passive activities and increase in the moderate activities. However, the participation in high-intensity activities according to age was negligible. Only 65 (61.3%) patients were considered active postoperatively (weekly spending ≥ 40 MET), although the WOMAC scores were not significantly different between active and sedentary patients. Active patients compared with sedentary patients had a significant increase in engagement in physical, social and leisure activities, and a decrease in passive activities. Female gender (p = 0.037), less preoperatively participation in passive activities (p = 0.042), and greater participation in social activities (p = 0.027) were significant predictors of active patients at the final follow-up. CONCLUSION Overall, most patients increased their activity level postoperatively. However, 38.6% of patients had no increased engagement in moderate physical, social or leisure activities at the medium-term despite improvements in pain and function provided by TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marta Rubio-Morales
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain.,Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain. .,Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - M Flores Vizcaya-Moreno
- Unit of Clinical Nursing Research, Faculty of Health Sciences, University of Alicante, Ctra S Vicente Raspeig s/n, 06390, Alicante, Spain
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Kunze KN, Estrada JA, Apostolakos J, Fu MC, Taylor SA, Gulotta LV, Dines DM, Dines JS. Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study. HSS J 2023; 19:85-91. [PMID: 36776520 PMCID: PMC9837403 DOI: 10.1177/15563316221104765] [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: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 02/14/2023]
Abstract
Background: Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. Purpose: We sought to investigate the potential association between TSA patients' use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. Results: Forty-one patients were included in each cohort, exceeding the minimum number required per an a priori power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort (n = 8 [19.5%] vs n = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. Conclusions: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge.
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Affiliation(s)
- Kyle N. Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jennifer A. Estrada
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John Apostolakos
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael C. Fu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A. Taylor
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V. Gulotta
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - David M. Dines
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S. Dines
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
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11
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Relationship between Postoperative Pain and Sociocultural Level in Major Orthopedic Surgery. Adv Orthop 2022; 2022:7867719. [PMID: 36267670 PMCID: PMC9578872 DOI: 10.1155/2022/7867719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with moderate to severe postoperative pain (POP). POP is theoretically predictable and may be influenced by sociocultural differences. This study aimed to identify the relationship between POP and the sociocultural level of the patient undergoing THA or TKA. Methods Prospective study, involving informed-consenting adults conducted through consulting patient's clinical processes, preoperative and postoperative questionnaires. Demographic and anthropometric data, type of surgery, ASA classification, sociocultural level of the patient, and POP were assessed. Results 95 patients, all Caucasian and natural from the north of the Portugal, were included. Younger women undergoing TKA reported higher levels of POP. In females, the ASA 3 physical condition was also associated with higher mean pain intensity. Patients with preoperative chronic pain, without depression diagnosis, and unsatisfied with the current profession showed higher levels of reported POP. Retirees, with lower school degree, reported higher levels of minimal pain. Conclusions Job satisfaction, type of surgery, body mass index, presence of chronic pain, and the absence of depression were identified as the main predictors of pain after THA or TKA.
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12
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Nguyen KH, Rambachan A, Ward DT, Manuel SP. Language barriers and postoperative opioid prescription use after total knee arthroplasty. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100171. [PMID: 36082144 PMCID: PMC9445381 DOI: 10.1016/j.rcsop.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/03/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with limited English proficiency (LEP) face difficulties in access to postoperative follow-up care, including post-discharge medication refills. However, prior studies have not examined how utilization of prescription pain medications after discharge from joint replacement surgeries differs between English proficient (EP) and LEP patients. Objective This study explored the relationship between English language proficiency and opioid prescription refill requests after hospital discharge for total knee arthroplasty (TKA). Methods This was an observational cohort study of patients ≥18 years of age who underwent TKA between January 2015 and December 2019 at a single academic center. LEP status was defined as not having English as the primary language and requesting an interpreter. Primary outcome variables included opioid pain medication refill requests between 0 and 90 days from discharge. Multivariable logistic regression modeling calculated the odds ratios of requesting an opioid refill. Results A total of 2148 patients underwent TKA, and 9.8% had LEP. Postoperative pain levels and rates of prior opioid use did not differ between LEP and EP patients. LEP patients were less likely to request an opioid prescription refill within 30 days (35.3% vs 52.4%, p < 0.001), 60 days (48.7% vs 61.0%, p = 0.004), and 90 days (54.0% vs 62.9%, p = 0.041) after discharge. In multivariable analysis, LEP patients had an odds ratio of 0.61 of requesting an opioid refill (95% CI, 0.41–0.92, p = 0.019) within 30 days of discharge. Having Medicare insurance and longer lengths of hospitalization were correlated with lower odds of 0–30 days opioid refills, while prior opioid use and being discharged home were associated with higher odds of opioid refill requests 0–30 days after discharge for TKA. Conclusions Language barriers may contribute to poorer access to postoperative care, including prescription medication refills. Barriers to postoperative care may exist at multiple levels for LEP patients undergoing surgical procedures.
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13
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional Outcomes Following Hip Replacement in Community-Dwelling Older Adults. J Clin Med 2022; 11:jcm11175117. [PMID: 36079051 PMCID: PMC9457152 DOI: 10.3390/jcm11175117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Uncertainty remains regarding the benefit of hip replacement in older adults in the context of age-related decline in physical function. This study aimed to examine the effect of hip replacement on functional outcomes and identify factors associated with clinically important improvement in physical function postoperatively in community-dwelling older adults. This cohort study was performed within the ASPREE trial, with 698 participants receiving hip replacement and 677 age- and sex-matched controls without knee or hip replacement during the trial drawn from 16,703 Australian participants aged ≥70 years. Health status (physical and mental component summary [PCS and MCS]) was assessed annually using the SF-12. Participants receiving hip replacement had significantly lower pre- and post-replacement PCS scores compared with controls (p < 0.0001). There was significant improvement in PCS score following hip replacement (mean change 4.9, 95%CI 4.0−5.7) but no change in controls (0.01, 95%CI −0.7−0.7). Following hip replacement, 46.7% of participants experienced clinically important improvement in PCS score, while 15.5% experienced worsened PCS score. Participants experiencing improved postoperative PCS score had significantly lower PCS and higher MCS scores preoperatively. The degree of preoperative physical function impairment was a significant indicator of older people most likely to benefit from hip replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Sharyn M. Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Susan Liew
- Alfred Hospital, Melbourne 3004, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Anita E. Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Correspondence: ; Tel.: +61-39-9030158
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14
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STISEN MB, KLENØ AN, JACOBSEN JS, O’CONNELL MDL, AYIS S, SACKLEY C, PEDERSEN AB, MECHLENBURG I. Do changes in outcomes following primary and revision hip replacement differ and relate to markers of socioeconomic status? A 1-year population-based cohort study. Acta Orthop 2022; 93:397-404. [PMID: 35383857 PMCID: PMC8985216 DOI: 10.2340/17453674.2022.2430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There is little evidence on improvement after revision total hip replacement (THR). Moreover, improvements may be associated with socioeconomic status (SES). We investigated whether changes in Harris Hip Score (HHS) differ among patients undergoing primary and revision THR, and their association with markers of SES. PATIENTS AND METHODS We conducted a populationbased cohort study on 16,932 patients undergoing primary and/or revision THR from 1995 to 2018 due to hip osteoarthritis. The patients were identified in the Danish Hip Arthroplasty Registry. Outcome was defined as mean change in HHS (0-100) from baseline to 1-year follow-up, and its association with SES markers (education, cohabiting, and wealth) was analyzed using multiple linear regression adjusting for sex, age, comorbidities, and baseline HHS. RESULTS At 1-year follow-up, HHS improved clinically relevant for patients undergoing both primary THR: mean 43 (95% CI 43-43) and revision THR: mean 31 (CI 29-33); however, the increase was 12 points (CI 10-14) higher for primary THR. For primary THR, improvements were 0.9 points (CI 0.4-1.5) higher for patients with high educational level compared with low educational level, 0.4 points (CI 0.0-0.8) higher for patients cohabiting compared with living alone, and 2.6 points higher (CI 2.1-3.0) for patients with high wealth compared with low wealth. INTERPRETATION Patients undergoing primary THR achieve higher improvements on HHS than patients undergoing revision THR, and the improvements are negatively related to markers of low SES. Health professionals should be aware of these characteristics and be able to identify patients who may benefit from extra rehabilitation to improve outcomes after THR to ensure equality in health.
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Affiliation(s)
- Martin B STISEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - André N KLENØ
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Julie S JACOBSEN
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark,Research Unit for General Practice in Aarhus, Aarhus, Denmark
| | - Matthew D L O’CONNELL
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Salma AYIS
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Catherine SACKLEY
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Alma B PEDERSEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger MECHLENBURG
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Dowsey MM, Spelman T, Choong PFM. A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement. J Clin Med 2022; 11:jcm11061649. [PMID: 35329975 PMCID: PMC8955143 DOI: 10.3390/jcm11061649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Total hip replacement (THR) is a common and cost-effective procedure for end-stage osteoarthritis, but inappropriate utilization may be devaluing its true impact. The purpose of this study was to develop and test the internal validity of a prognostic algorithm for predicting the probability of non-response to THR surgery at 1 year. Methods: Analysis of outcome data extracted from an institutional registry of individuals (N = 2177) following elective THR performed between January 2012 and December 2019. OMERACT-OARSI responder criteria were applied to Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scores at pre- and 1 year post-THR, to determine non-response to surgery. Independent prognostic correlates of post-operative non-response observed in adjusted modelling were then used to develop a nomogram. Results: A total of 194 (8.9%) cases were deemed non-responders to THR. The degree of contribution (OR, 95% CI) of each explanatory factor to non-response on the nomogram was, morbid obesity (1.88, 1.16, 3.05), Kellgren−Lawrence grade <4 (1.89, 1.39, 2.56), WOMAC Global rating per 10 units (0.86, 0.79, 0.94) and the following co-morbidities: cerebrovascular disease (2.39, 1.33, 4.30), chronic pulmonary disease (1.64; 1.00, 2.71), connective tissue disease (1.99, 1.17, 3.39), diabetes (1.86, 1.26, 2.75) and liver disease (2.28, 0.99, 5.27). The concordance index for the nomogram was 0.70. Conclusion: We have developed a prognostic nomogram to calculate the probability of non-response to THR surgery. In doing so, we determined that both the probability of and predictive prognostic factors for non-response to THR differed from a previously developed nomogram for total knee replacement (TKR), confirming the benefit of designing decision support tools that are both condition and surgery site specific. Future external validation of the nomogram is required to confirm its generalisability.
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Affiliation(s)
- Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Correspondence: ; Tel.: +61-3-9288-3955; Fax: +61-3-9416-3610
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
| | - Peter F. M. Choong
- Department of Surgery, The University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (T.S.); (P.F.M.C.)
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
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16
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1-year trajectories of patients undergoing primary total hip arthroplasty: Patient reported outcomes and resource needs according to education level. BMC Musculoskelet Disord 2022; 23:84. [PMID: 35078440 PMCID: PMC8790886 DOI: 10.1186/s12891-022-05004-6] [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] [Received: 03/22/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Objectives were first to evaluate by education level one-year trajectories of pain, function and general health, as well as hospital resource and medication needs in patients undergoing primary total hip arthroplasty (THA); and second, to evaluate whether outcome differences are related to existing baseline differences in health and disease severity.
Methods
We included all primary THAs from a public hospital-based prospective arthroplasty registry, performed in a high-income country 2010 to 2017. Education was classified in three levels: ≤8years of schooling (low), 9-12years (medium), and ≥13years (high). Pain and function prior to and one-year after surgery were assessed with the Western Ontario McMaster Universities score (WOMAC) and general health with the 12-item short-form health survey (SF-12).
Results
Overall 963 patients were included, 340 (35.3%) with low, 306 (31.8%) with medium, and 317 (32.9%) with high education. With increasing educational level preoperative scores for pain, function and SF-12 mental health component increased. One year after surgery improvement was observed in all education categories for WOMAC pain and function, SF-12 mental and physical component. However, absolute postoperative scores remained lower in all four domains for the low education group. After adjustment for baseline characteristics differences were much attenuated and no longer significant. There was also greater resource need in low educated patients.
Conclusions
The inferior absolute results one year after surgery in less educated patients were largely due to older age, worse preoperative health and greater symptom severity calling for greater attention to timely and equal management, for more targeted perioperative care and increased support for the lower education group.
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17
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Saks BR, Ouyang VW, Domb ES, Jimenez AE, Maldonado DR, Lall AC, Domb BG. Equality in Hip Arthroscopy Outcomes Can Be Achieved Regardless of Patient Socioeconomic Status. Am J Sports Med 2021; 49:3915-3924. [PMID: 34739305 DOI: 10.1177/03635465211046932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Access to quality health care and treatment outcomes can be affected by patients' socioeconomic status (SES). PURPOSE To evaluate the effect of patient SES on patient-reported outcome measures (PROMs) after arthroscopic hip surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Demographic, radiographic, and intraoperative data were prospectively collected and retrospectively reviewed on all patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear between February 2008 and September 2017 at one institution. Patients were divided into 4 cohorts based on the Social Deprivation Index (SDI) of their zip code. SDI is a composite measure that quantifies the level of disadvantage in certain geographical areas. Patients had a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool-12, and visual analog scale (VAS) for both pain and satisfaction. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the mHHS, NAHS, and VAS pain score. Rates of secondary surgery were also recorded. RESULTS A total of 680 hips (616 patients) were included. The mean follow-up time for the entire cohort was 30.25 months. Division of the cohort into quartiles based on the SDI national averages yielded 254 hips (37.4%) in group 1, 184 (27.1%) in group 2, 148 (21.8%) in group 3, and 94 (13.8%) in group 4. Group 1 contained the most affluent patients. There were significantly more men in group 4 than in group 2, and the mean body mass index was greater in group 4 than in groups 1 and 2. There were no differences in preoperative radiographic measurements, intraoperative findings, or rates of concomitant procedures performed. All preoperative and postoperative PROMs were similar between the groups, as well as in the rates of achieving the MCID or PASS. No differences in the rate of secondary surgeries were reported. CONCLUSION Regardless of SES, patients were able to achieve significant improvements in several PROMs after hip arthroscopy for FAIS and labral tear at the minimum 2-year follow-up. Additionally, patients from all SES groups achieved clinically meaningful improvement at similar rates.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Elijah S Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
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18
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Mehta B, Goodman S, Ho K, Parks M, Ibrahim SA. Community Deprivation Index and Discharge Destination After Elective Hip Replacement. Arthritis Care Res (Hoboken) 2021; 73:531-539. [PMID: 31961488 DOI: 10.1002/acr.24145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine how the deprivation level of the community in which one lives influences discharge disposition and the odds of 90-day readmission after elective total hip arthroplasty (THA). METHODS We performed a retrospective cohort study on 84,931 patients who underwent elective THA in the Pennsylvania Health Care Cost Containment Council database from 2012 to 2016. We used adjusted binary logistic regression models to test the association between community Area Deprivation Index (ADI) level and patient discharge destination as well as 90-day readmission. We included an interaction term for community ADI level and patient race in our models to assess the simultaneous effect of both on the outcomes. RESULTS After adjusting for patient- and facility-level characteristics, we found that patients from high ADI level communities (most disadvantaged), compared to patients from low ADI level communities (least disadvantaged), were more likely to be discharged to an institution as opposed to home for postoperative care and rehabilitation (age <65 years adjusted odds ratio [ORadj ] 1.47; age ≥65 years ORadj 1.31; both P < 0.001). The interaction effect of patient race and ADI level on discharge destination was statistically significant in those patients age ≥65 years, but not in patients age <65 years. The association with ADI level on 90-day readmission was not statistically significant. CONCLUSION In this statewide sample of patients who underwent elective THA, the level of deprivation of the community in which patients reside influences their discharge disposition, but not their odds of 90-day readmission to an acute-care facility.
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Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery, New York, New York
| | | | - Kaylee Ho
- Weill Cornell Medicine, New York, New York
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19
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The Need for an Interpreter Increases Length of Stay and Influences Postoperative Disposition Following Primary Total Joint Arthroplasty. J Arthroplasty 2020; 35:2405-2409. [PMID: 32446624 DOI: 10.1016/j.arth.2020.04.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Many US patients who undergo total joint arthroplasty have low English proficiency, yet no study has investigated how the need for a translator impacts postoperative outcomes for these patients. We hypothesized that need for an interpreter after total joint arthroplasty would impact discharge disposition and length of stay. METHODS We performed a retrospective chart review of patients at a single large urban academic institution undergoing single primary total joint replacement from July 2016 to November 2019. Patients were classified as primarily English speaking (E), non-English primary language and did not require an interpreter (NE-N), or non-English primary language and did require an interpreter (NE-I). Data on patient characteristics, length of stay, and discharge disposition were collected. RESULTS Total hip arthroplasty (THA) patients in the NE-I group had significantly longer length of stay than both the NE-N group (2.85 vs 2.28 days, P = .015) and the E group (2.85 s vs 1.87 days, P < .0001). THA patients who required a translator were also significantly less likely to be discharged to home than those who were primarily English speaking (71.4% vs 88.8%, P < .0001). Total knee arthroplasty (TKA) patients in the NE-I group had significantly longer length of stay than the E group (2.66 vs 2.50 days, P = .009). The TKA patients in the NE-I group were significantly less likely to be discharged home than in the E group (74.5% vs 82.4%, P < .0001). CONCLUSION Although interpreter services are provided by the hospital for NE-I patients, the communication barrier that exists affects both length of stay and discharge disposition for both THA and TKA.
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20
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Austin DC, Torchia MT, Moschetti WE, Jevsevar DS, Keeney BJ. Patient outcomes after total hip arthroplasty in extreme elderly patients older than 80 years. Hip Int 2020; 30:407-416. [PMID: 30945561 DOI: 10.1177/1120700019837943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND While extreme elderly patients (age 80 and above) benefit from joint replacement, there is controversy about whether their physical function improves as much as younger individuals following total hip arthroplasty. METHODS We completed a retrospective cohort study comparing extreme elderly total hip arthroplasty (THA) patients to younger patients. We obtained data from a large institutional repository of 2327 consecutive THAs performed from April 2011 through July 2016 at an American academic medical centre. We performed multivariate regression analyses to determine associations between age group and clinically significant improvement in the Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) score. Secondary outcomes included the magnitude of PCS change, length of stay (LOS), and facility discharge. RESULTS There were 187 THAs (8.0%) in patients age ⩾ 80 years compared to 2140 THA procedures in patients < age 80. Extreme elderly patients had similar adjusted odds of achieving clinically significant PCS improvement after THA (p = 0.528) and there were no statistical differences in adjusted postoperative PCS score improvements between the cohorts. Extreme elderly patients were associated with a 0.68 day longer adjusted LOS (p < 0.001) and demonstrated higher adjusted odds of facility discharge following THA (OR 8.96, p < 0.001). CONCLUSIONS Compared to younger patients, extreme elderly individuals had similar adjusted postoperative functional outcomes following THA but utilised substantially more resources in the form of increased time in the hospital and higher rates of facility discharges.
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Affiliation(s)
- Daniel C Austin
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael T Torchia
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Benjamin J Keeney
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.,Berkley Medical Management Solutions, Overland Park, KS, USA
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Pronk Y, Peters MCWM, Sheombar A, Brinkman JM. Effectiveness of a Mobile eHealth App in Guiding Patients in Pain Control and Opiate Use After Total Knee Replacement: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16415. [PMID: 32167483 PMCID: PMC7101497 DOI: 10.2196/16415] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 12/16/2022] Open
Abstract
Background Little is known about pain and opiate use at home directly after total knee replacement (TKR). Due to adverse effects, low opiate use is desired. An electronic health app (PainCoach) was developed to guide patients in pain control and opiate use. Objective The aim of this paper was to investigate the effects of the PainCoach app on pain control and opiate use in patients who underwent TKR during the first 2 weeks at home after surgery. Methods In an unblinded randomized controlled trial, patients scheduled for TKR were offline recruited and randomized to a PainCoach group or control group. In the PainCoach group, the PainCoach app was downloaded on each patient’s smartphone or tablet. In response to the patient’s input of the pain experienced, the PainCoach app gave advice on pain medication use, exercises/rest, and when to call the clinic. This advice was the same as that received during usual care. The control group received usual care. The primary outcomes were opiate use and visual analog scale (VAS) pain scores at rest, during activity, and at night during the first 2 weeks at home after surgery, which were collected daily from day 1 until 14 postoperatively by online questionnaires. The actual amount of app use was recorded, and active use was defined as ≥12 total app uses. Results The pain scores did not differ between the groups. The PainCoach group (n=38) used 23.2% less opiates (95% CI −38.3 to −4.4; P=.02) and 14.6% more acetaminophen (95% CI 8.2-21.3; P<.001) when compared with the findings in the control group (n=33). The PainCoach app was used 12 (IQR 4.5-22.0) times per patient. In the active PainCoach subgroup (n=19), the following were noted when compared with the findings in the control group: 4.1 times faster reduction of the VAS pain score during activity (95% CI −7.5 to −0.8; P=.02), 6.3 times faster reduction of the VAS pain score at night (95% CI −10.1 to −2.6; P=.001), 44.3% less opiate use (95% CI −59.4 to −23.5; P<.001), 76.3% less gabapentin use (95% CI −86.0 to −59.8; P<.001), and 21.0% more acetaminophen use (95% CI 12.6-30.0; P<.001). Conclusions The use of the PainCoach app contributes to reduced opiate use in the initial period at home after TKR. Active use of this app leads to a further reduction in opiate use and improved pain control. Trial Registration ClinicalTrials.gov NCT03961152; https://clinicaltrials.gov/ct2/show/NCT03961152
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, Netherlands
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22
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Li X, Galvin JW, Li C, Agrawal R, Curry EJ. The Impact of Socioeconomic Status on Outcomes in Orthopaedic Surgery. J Bone Joint Surg Am 2020; 102:428-444. [PMID: 31833981 DOI: 10.2106/jbjs.19.00504] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Chris Li
- Northeastern University, Boston, Massachusetts
| | - Ravi Agrawal
- Boston University School of Medicine, Boston, Massachusetts
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts
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Singh JA, Cleveland JD. Insurance Payer Type and Patient Income Are Associated with Outcomes after Total Shoulder Arthroplasty. J Rheumatol 2019; 47:589-596. [PMID: 31154417 DOI: 10.3899/jrheum.190287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the independent association of insurance and patient income with total shoulder arthroplasty (TSA) outcomes. METHODS We used the 1998-2014 US National Inpatient Sample. We used multivariable-adjusted logistic regression to examine whether insurance type and the patient's median household income (based on postal code) were independently associated with healthcare use (discharge destination, hospital stay duration, total hospital charges) and in-hospital complications post-TSA based on the diagnostic codes (fracture, infection, transfusion, or revision surgery). We calculated the OR and 95% CI. RESULTS Among the 349,046 projected TSA hospitalizations, the mean age was 68.6 years, 54% were female, and 73% white. Compared to private insurance, Medicaid and Medicare (government insurance) users were associated with significantly higher adjusted OR (95% CI) of (1) discharge to a rehabilitation facility, 2.16 (1.72-2.70) and 2.27 (2.04-2.52); (2) hospital stay > 2 days, 1.65 (1.45-1.87) and 1.60 (1.52-1.69); and (3) transfusion, 1.35 (1.05-1.75) and 1.39 (1.24-1.56), respectively. Medicaid was associated with a higher risk of fracture [1.74 (1.07-2.84)] and Medicare user with a higher risk of infection [2.63 (1.24-5.57)]; neither were associated with revision. Compared to the highest income quartile, the lowest income quartile was significantly associated with (OR, 95% CI): (1) discharge to a rehabilitation facility (0.89, 0.83-0.96); (2) hospital stay > 2 days (0.84, 0.80-0.89); (3) hospital charges above the median (1.19, 1.14-1.25); (4) transfusion (0.73, 0.66-0.81); and (5) revision (0.49, 0.30-0.80), but not infection or fracture. CONCLUSION This information can help to risk-stratify patients post-TSA. Future assessments of modifiable mediators of these complications are needed.
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Affiliation(s)
- Jasvinder A Singh
- From the Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. .,J.A. Singh, MBBS, MPH, Birmingham VA Medical Center, and Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham; J.D. Cleveland, MS, Department of Medicine at the School of Medicine, University of Alabama at Birmingham.
| | - John D Cleveland
- From the Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.A. Singh, MBBS, MPH, Birmingham VA Medical Center, and Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham; J.D. Cleveland, MS, Department of Medicine at the School of Medicine, University of Alabama at Birmingham
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24
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Austin DC, Torchia MT, Moschetti WE, Jevsevar DS, Keeney BJ. Patient Outcomes After Total Knee Arthroplasty in Patients Older Than 80 Years. J Arthroplasty 2018; 33:3465-3473. [PMID: 30100133 DOI: 10.1016/j.arth.2018.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/27/2018] [Accepted: 07/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patients aged 80 and above who suffer from end-stage osteoarthritis may benefit from total knee arthroplasty (TKA), but at high potential risk. Additionally, there is controversy about whether functional improvement in patients above age 80 is similar to younger patients. We compared functional improvement, length of stay (LOS), and facility discharge rates after TKA between this cohort and patients less than 80 years of age. METHODS We completed a retrospective cohort study comparing TKA patients aged 80 and above with all patients younger than 80. We utilized data from a prospectively collected institutional repository of 2308 TKAs performed from April 2011 through July 2016 at an academic medical center in the United States. We performed multivariable logistic regression to determine the association between age group and clinically significant improvement in the Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) score. Secondary outcomes included the magnitude of PCS change, LOS, and facility discharge. RESULTS There were 175 (7.6%) TKAs in patients older than 80 years compared with 2133 TKAs in patients younger than 80. Patients over 80 had similar adjusted odds of achieving clinically significant PCS improvement following TKA (P = .366), and there was no statistical difference in adjusted postoperative PCS improvement between the 2 age groups. Age 80 and above was associated with a longer adjusted LOS and demonstrated increased odds of facility discharge (odds ratio 4.11, P < .001) after TKA. CONCLUSION Following TKA, patients older than 80 years demonstrate similar adjusted functional improvement in comparison to younger patients. However, older patients did require substantially more resources as they remained in the hospital longer and were discharged to rehabilitation more often.
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Affiliation(s)
- Daniel C Austin
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, North Hampshire
| | - Michael T Torchia
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, North Hampshire
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, North Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, North Hampshire
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, North Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, North Hampshire
| | - Benjamin J Keeney
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, North Hampshire; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, North Hampshire; Berkley Medical Management Solutions, Overland Park, Kansas
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25
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Murphy BPD, Dowsey MM, Spelman T, Choong PFM. The impact of older age on patient outcomes following primary total knee arthroplasty. Bone Joint J 2018; 100-B:1463-1470. [DOI: 10.1302/0301-620x.100b11.bjj-2017-0753.r6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims As the population ages, there is projected to be an increase in the level of demand for total knee arthroplasty (TKA) in octogenarians. We aimed to explore whether those aged ≥ 80 years achieved similar improvements in physical function to younger patients while also comparing the rates of length of stay (LOS), discharge to rehabilitation, postoperative complications, and mortality following TKA in older and younger patients. Patients and Methods Patients from one institution who underwent primary elective TKA between 1 January 2006 and 31 December 2014 were dichotomized into those ≥ 80 years old (n = 359) and those < 80 years old (n = 2479) for comparison. Multivariable regression was used to compare the physical status component of the 12-Item Short-Form Health Survey (SF-12), LOS, discharge to rehabilitation, complications, and mortality between the two groups. Results Both age groups demonstrated a clinically meaningful improvement in their self-reported physical health relative to their baseline with no clinically relevant difference noted between them. Being ≥ 80 years old was associated with a 0.58-day increase in LOS and older patients were more likely to be discharged to rehabilitation (odds ratio (OR) 3.06, p < 0.001). Medical complications and mortality were higher in elderly patients (OR 1.92 for complications, p < 0.001; hazard ratio 3.40 for death, p < 0.001). There was no statistically significant association between age group and experiencing a postoperative surgical or wound-related complication. Conclusion Those aged over 80 years achieved a statistically significant lower median SF-12 physical score than the younger group, after adjusting for the preoperative score, but this difference of 4.46 was not considered to be clinically meaningful. However, clinicians should be aware that the elderly are at a higher risk of experiencing longer hospital stays, postoperative medical complications, and mortality. Cite this article: Bone Joint J 2018;100-B:1463–70.
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Affiliation(s)
- B. P. d’S. Murphy
- School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - M. M. Dowsey
- The University of Melbourne and St. Vincent’s Hospital Melbourne, Melbourne, Australia
| | - T. Spelman
- The University of Melbourne and St. Vincent’s Hospital Melbourne, Melbourne, Australia
| | - P. F. M. Choong
- The University of Melbourne and St. Vincent’s Hospital Melbourne, Melbourne, Australia
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Abstract
BACKGROUND Both obesity and underweight are associated with a higher risk of mortality in adulthood, but the association between mortality after arthroplasty and extreme ranges of body mass index (BMI) have not been evaluated beyond the first year. QUESTIONS/PURPOSES The purpose of this study was to investigate the association between BMI and all-cause mortality after TKA and THA. METHODS Data from two arthroplasty registries, the St Vincent's Melbourne Arthroplasty (SMART) Registry from Australia and the Kaiser Permanente Total Joint Replacement Registry (KPTJRR) from the United States, were used to identify patients aged ≥ 18 years undergoing elective TKAs and THAs between January 1, 2002, and December 31, 2013. Same-day bilateral THA and hemiarthroplasties were excluded. All-cause mortality was recorded from the day of surgery to the end of the study (December 31, 2013). Data capture was complete for the SMART Registry. No patients were lost to followup in the KPTJRR cohort and 2959 (5%) THAs and 5251 (5%) TKAs had missing data. Cox proportional hazard regression was used to estimate the all-cause mortality associated with six BMI categories: underweight (< 18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25.0-29.9 kg/m), obese class I (30.0-34.9 kg/m), obese class II (35.0-39.9 kg/m), and obese class III (> 40 kg/m). For TKA, the SMART cohort had a median followup of 5 years (range, 0-12 years) and the KPTJRR cohort had a median followup of 4 years (range, 0-12 years). For THA, the SMART cohort had a median followup of 5 years (range, 0-12 years) and the KPTJRR cohort had a median followup of 4 years (range, 0-12 years). RESULTS In both the Australian and US cohorts, being underweight (Australia: hazard ratio [HR], 3.72; 95% confidence interval [CI], 1.94-7.08; p < 0.001 and United States: HR, 1.88; 95% CI, 1.33-2.64; p < 0.001) was associated with higher all-cause mortality after TKA, whereas obese class I (Australia: HR, 0.66; 95% CI, 0.47-0.92; p = 0.015; United States: HR, 0.71; 95% CI, 0.66-0.78; p < 0.001) or obese class II (Australia: HR, 0.54; 95% CI, 0.35-0.82; p = 0.004; United States: HR, 0.73; 95% CI, 0.66-0.81; p < 0.001) was associated with lower mortality when compared with normal-weight patients. In the US cohort, being overweight was also associated with a lower risk of mortality (HR, 0.76; 95% CI, 0.71-0.82; p < 0.001). In the US cohort, being underweight had a higher risk of mortality after THA (HR, 2.09; 95% CI, 1.65-2.64; p < 0.001), whereas those overweight (HR, 0.73; 95% CI, 0.67-0.80; p < 0.001), obese class I (HR, 0.68; 95% CI, 0.62-0.75; p < 0.001), or obese class II (HR, 0.71; 95% CI, 0.62-0.81; p < 0.001) were at a lower risk of mortality after THA when compared with normal-weight patients. In patients undergoing THA in the Australian cohort, we observed no association between BMI and risk of death. CONCLUSIONS We found that even severe obesity is not associated with a higher risk of death after arthroplasty. Patients should be informed of this when considering surgery. Clinicians should be cautious when considering total joint arthroplasty in underweight patients without first considering their nutritional status. LEVEL OF EVIDENCE Level III, therapeutic study.
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27
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Murphy BPD, Dowsey MM, Spelman T, Choong PFM. What Is the Impact of Advancing Age on the Outcomes of Total Hip Arthroplasty? J Arthroplasty 2018; 33:1101-1107.e1. [PMID: 29208330 DOI: 10.1016/j.arth.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The global demand for total hip arthroplasty (THA) is increasing, underscoring its moniker as the "operation of the century." However, debate still exists as to whether the elderly who undergo the operation achieve the same outcomes as those younger. In this study, we sought to investigate the association between older age and the risks and benefits of THA. METHODS In this study, we aimed to compare the risks and benefits of THA of those aged ≥80 years vs those <80 years. We analyzed the physical status component of the Short-Form 12 Health Survey, complications within 12 months, all-cause mortality, length of hospital stay (LOS), and discharge to rehabilitation in 2457 cases of primary THA using multivariate modeling. RESULTS There was no difference in improvement of those older vs the younger group in physical functioning. However, the older group had 2.87 times greater odds of experiencing a post-operative medical complication and 3.49 times the rate of all-cause mortality (P < .001). Additionally, the older group encountered an additional median 0.21-day increase in LOS and had 3.93 times greater odds of being discharged to rehabilitation rather than home (P < .001). We were unable to demonstrate any difference between groups in terms of post-operative surgical or wound-related complications. CONCLUSION The elderly stand to gain equivalent benefits from THA as those younger in terms of physical functioning. However, this benefit needs to be balanced against the increased risk of post-operative medical complications, increased LOS, increased requirement for rehabilitation, and ultimately the increased risk of mortality.
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Affiliation(s)
- Benjamin P d'S Murphy
- School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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28
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Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW, Pinedo-Villanueva R. Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:1455-1464. [PMID: 28032123 PMCID: PMC5907625 DOI: 10.1007/s00167-016-4404-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 12/07/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE For patients with medial compartment arthritis who have failed non-operative treatment, either a total knee arthroplasty (TKA) or a unicompartmental knee arthroplasty (UKA) can be undertaken. This analysis considers how the choice between UKA and TKA affects long-term patient-reported outcome measures (PROMs). METHODS The Knee Arthroplasty Trial (KAT) and a cohort of patients who received a minimally invasive UKA provided data. Propensity score matching was used to identify comparable patients. Oxford Knee Score (OKS), its pain and function components, and the EuroQol 5 Domain (EQ-5D) index, estimated on the basis of OKS responses, were then compared over 10 years following surgery. Mixed-effects regressions for repeated measures were used to estimate the effect of patient characteristics and type of surgery on PROMs. RESULTS Five-hundred and ninety UKAs were matched to the same number of TKAs. Receiving UKA rather than TKA was found to be associated with better scores for OKS, including both its pain and function components, and EQ-5D, with the differences expected to grow over time. UKA was also associated with an increased likelihood of patients achieving a successful outcome, with an increased chance of attaining minimally clinically important improvements in both OKS and EQ-5D, and an 'excellent' OKS. In addition, for both procedures, patients aged between 60 and 70 and better pre-operative scores were associated with better post-operative outcomes. CONCLUSION Minimally invasive UKAs performed on patients with the appropriate indications led to better patient-reported pain and function scores than TKAs performed on comparable patients. UKA can lead to better long-term quality of life than TKA and this should be considered alongside risk of revision when choosing between the procedures. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Edward Burn
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - Maria T. Sanchez-Santos
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK ,0000 0004 1936 8948grid.4991.5Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - Hemant G. Pandit
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK ,0000 0001 0440 1440grid.410556.3Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7LD UK
| | - Thomas W. Hamilton
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Alexander D. Liddle
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK ,0000000121901201grid.83440.3bInstitute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, University College London, Stanmore, Middlesex HA7 4LP UK
| | - David W. Murray
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK ,0000 0001 0440 1440grid.410556.3Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7LD UK
| | - Rafael Pinedo-Villanueva
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK ,0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
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29
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Harmelink KEM, Zeegers AVCM, Hullegie W, Hoogeboom TJ, Nijhuis-van der Sanden MWG, Staal JB. Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review. J Arthroplasty 2017; 32:3840-3853.e1. [PMID: 28927646 DOI: 10.1016/j.arth.2017.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 07/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified. METHODS Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies. RESULTS A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life. CONCLUSION Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points. Systematic review registration number: CRD42015026814.
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Affiliation(s)
- Karen E M Harmelink
- FysioHolland Twente, Enschede, The Netherlands; Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Adelgunde V C M Zeegers
- Department of Orthopaedic Surgery, Medisch Spectrum Twente (MST), Haaksbergen, The Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie & Richter, Enschede, The Netherlands
| | - Thomas J Hoogeboom
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | | | - J Bart Staal
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
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30
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Aalund PK, Glassou EN, Hansen TB. The impact of age and preoperative health-related quality of life on patient-reported improvements after total hip arthroplasty. Clin Interv Aging 2017; 12:1951-1956. [PMID: 29180858 PMCID: PMC5694207 DOI: 10.2147/cia.s149493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a common surgical procedure and approximately 9,500 of these surgeries are performed annually in Denmark. The operation is considered effective and successful with respect to complications, mortality, and implant survival. However, using patient-reported outcome measures, up to 10% of patients are not satisfied with the outcome of their operation. To address this, it is important to find out why some patients experience impaired outcomes after THA. The purpose of this study was to investigate the impact of age and preoperative health-related quality of life (HRQoL) on improvements in HRQoL after THA. Methods A cohort study was conducted with follow-up at 3 and 12 months. Patients were included from September 2008 to December 2013. We analyzed 1,283 THA cases. HRQoL was measured using the EuroQol-5 Domain. Analyses were carried out with multiple linear regression and adjusted for relevant variables available in the data set. Results A significant positive association was found between age and HRQoL outcomes for patients who underwent THA at both 3 (β [regression coefficient] 0.0026, confidence interval [CI] 0.0013; 0.0039, p<0.001) and 12 (β 0.0020 CI 0.0008; 0.0032, p=0.001) months of follow-up. A clinically relevant change was achieved with an increase in age of 12–15 years. A significant negative association was found between preoperative HRQoL and HRQoL outcomes at both 3 (β −0.841 CI −0.886; −0.795, p<0.001) and 12 (β −0.804 CI −0.844; −0.764, p<0.001) months of follow-up. Conclusion Contrary to our expectations, older patients had more improvements in HRQoL outcomes after THA. A high preoperative HRQoL seems to inhibit improvements in HRQoLs after THA.
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Affiliation(s)
- Peter K Aalund
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Aarhus University, Holstebro, Denmark
| | - Eva N Glassou
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Aarhus University, Holstebro, Denmark
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Aarhus University, Holstebro, Denmark
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31
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Pathak S, Ganduglia CM, Awad SS, Chan W, Swint JM, Morgan RO. What Factors are Associated With 90-day Episode-of-care Payments for Younger Patients With Total Joint Arthroplasty? Clin Orthop Relat Res 2017; 475:2808-2818. [PMID: 28707110 PMCID: PMC5638736 DOI: 10.1007/s11999-017-5444-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/06/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inpatient and postdischarge care service-component differences across 90-day episodes of care and factors associated with payments for younger patients is crucial for successful implementation of bundled payments in TJA in non-Medicare populations. PURPOSE (1) To assess the mean total payment for a 90-day primary TJA episode, including the proportion attributable to postdischarge care, and (2) to evaluate the role of procedure, patient, and hospital-level factors associated with 90-day episode-of-care payments in a non-Medicare patient population younger than 65 years. METHOD Claims data for 2008 to 2013 from Blue Cross Blue Shield of Texas were obtained for primary TJAs. A total of 11,131 procedures were examined by aggregating payments for the index hospital stay and any postacute care including rehabilitation services and unplanned readmissions during the 90-day postdischarge followup period. A three-level hierarchical model was developed to determine procedure-, patient-, and hospital-level factors associated with 90-day episode-of-care payments. RESULTS The mean total payment for a 90-day episode for TJA was USD 47,700 adjusted to 2013 USD. Only 14% of 90-day episode payments in our population was attributable to postdischarge-care services, which is substantially lower than the percentage estimated in the Medicare population. A prolonged length of stay (rate ratio [RR], 1.19; 95% CI, 1.15-1.23; p ≤ 0.001), any 90-day unplanned readmission (RR, 1.64; 95% CI, 1.57-1.71; p ≤ 0.001), computer-assisted surgery (RR, 1.031; 95% CI, 1.004-1.059; p ≤ 0.05), initial home discharge with home health component (RR, 1.029; 95% CI, 1.013-1.046; p ≤ 0.001), and very high patient morbidity burden (RR, 1.105; 95% CI, 1.062-1.150; p ≤ 0.001) were associated with increased TJA payments. Hospital-level factors associated with higher payments included urban location (RR, 1.29; 95% CI, 1.17-1.42; p ≤ 0.001), lower hospital case mix based on average relative diagnosis related group weight (RR, 0.94; 95% CI, 0.89-0.95; p ≤ 0.001), and large hospital size as defined by total discharge volume (RR, 1.082; 95% CI, 1.009-1.161; p ≤ 0.05). All procedure, patient, and hospital characterizing factors together explained 11% of variation among hospitals and 49% of variation among patients. CONCLUSION Inpatient care contributed to a much larger proportion of total payments for 90-day care episodes for primary TJA in our younger than 65-year-old commercially insured population. Thus, inpatient care will continue to be an essential target for cost-containment and delivery strategies. A high percentage of hospital-level variation in episode payments remained unexplained by hospital characteristics in our study, suggesting system inefficiencies that could be suitable for bundling. However, replication of this study among other commercial payers in other parts of the country will allow for conclusions that are more robust and generalizable. LEVEL OF EVIDENCE Level II, economic analysis.
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Affiliation(s)
- Shweta Pathak
- grid.468222.8School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Blvd., Houston, TX 77030 USA
| | - Cecilia M. Ganduglia
- grid.468222.8School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Blvd., Houston, TX 77030 USA
| | - Samir S. Awad
- 0000 0004 0420 5521grid.413890.7Operative Care Line, Surgery Service, Michael E. DeBakey VA Medical Center, Houston, TX USA ,0000 0001 2160 926Xgrid.39382.33Department of Surgery, Baylor College of Medicine, Houston, TX USA
| | - Wenyaw Chan
- grid.468222.8School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Blvd., Houston, TX 77030 USA
| | - John M. Swint
- grid.468222.8School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Blvd., Houston, TX 77030 USA ,0000 0000 9206 2401grid.267308.8The Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Fannin, Houston, TX USA
| | - Robert O. Morgan
- grid.468222.8School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Blvd., Houston, TX 77030 USA
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Lange T, Rataj E, Kopkow C, Lützner J, Günther KP, Schmitt J. Outcome Assessment in Total Knee Arthroplasty: A Systematic Review and Critical Appraisal. J Arthroplasty 2017; 32:653-665.e1. [PMID: 28341034 DOI: 10.1016/j.arth.2016.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. METHODS Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. RESULTS This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. CONCLUSION More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.
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Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Schilling CG, Dowsey MM, Petrie DJ, Clarke PM, Choong PF. Predicting the Long-Term Gains in Health-Related Quality of Life After Total Knee Arthroplasty. J Arthroplasty 2017; 32:395-401.e2. [PMID: 27612604 DOI: 10.1016/j.arth.2016.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We investigated the predictors of long-term gains in quality-adjusted life years (QALYs) from total knee arthroplasty (TKA) and the patient attributes that predicted cost-effective TKA. METHODS Data on TKA patients (n = 570) from 2006 to 2007 were extracted from a single-institution registry. QALY gains over 7 years post surgery were calculated from health-related quality of life (HrQoL) scores measured preoperatively and annually postoperatively using the short-form health survey (SF-12) instrument. Multivariate linear regression analysis investigated the predictors of QALY gain from TKA from a broad range of preoperative patient characteristics and was used to predict QALY gains for each individual. Patients were grouped into deciles according to their predicted QALY gain, and the cost-effectiveness of each decile was plotted on the cost-effectiveness plane. Patient attribute differences between deciles were decomposed. RESULTS After exclusions and dropout, data were available for 488 patients. The average estimated QALY gain over 7 years was 0.77 (95% confidence interval [CI] 0.70-0.83). Predictors significantly associated with smaller QALY gains were comorbidities (Charlson comorbidity index 3+ coefficient -0.54 CI -0.15 to -0.92), the absence of severe osteoarthritis in the ipsilateral knee (-0.51 CI -0.16 to -0.85), preoperative HrQoL (standardized coefficient -0.34 CI -0.26 to -0.43), the requirement for an interpreter (-0.24 CI -0.05 to -0.44), and age (-0.01 CI -0.01 to -0.02). The largest difference between cost-effective and non-cost-effective deciles was relatively high preoperative HrQoL in the non-cost-effective decile. CONCLUSION TKA is likely to be cost-effective for most patients except those with unusually high preoperative HrQoL or a lack of severe osteoarthritis. The poorer outcomes for those requiring an interpreter requires further research.
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Affiliation(s)
- Chris G Schilling
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria; Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria
| | - Dennis J Petrie
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - Philip M Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria
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Predictors of Patient-Reported Pain and Functional Outcomes Over 10 Years After Primary Total Knee Arthroplasty: A Prospective Cohort Study. J Arthroplasty 2017; 32:92-100.e2. [PMID: 27444848 PMCID: PMC5178876 DOI: 10.1016/j.arth.2016.06.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed at identifying preoperative predictors of patient-reported outcomes after total knee arthroplasty (TKA) and at investigating their association with the outcomes over time. METHODS We used data from 2080 patients from the Knee Arthroplasty Trial who received primary TKA in the United Kingdom between July 1999 and January 2003. The primary outcome measure was the Oxford knee score (OKS) collected annually over 10 years after TKA. Preoperative predictors included a range of patient characteristics and clinical conditions. Mixed-effects linear regression model analysis of repeated measurements was used to identify predictors of overall OKS, and pain and function subscale scores over 10 years, separately. RESULTS Worse preoperative OKS, worse mental well-being, body mass index greater than 35 kg/m2, living in the most deprived areas, higher American Society of Anesthesiologists grade, presence of comorbidities, and history of previous knee surgery were associated with worse overall OKS over 10 years after surgery. The same predictors were identified for pain and function subscale scores, and for both long-term (10 years) and short-to-medium-term outcomes (1 and 5 years). However, fitted models explained more variations in function and shorter-term outcomes than in pain and longer-term outcomes, respectively. CONCLUSION The same predictors were identified for pain and functional outcomes over both short-to-medium term and long term after TKA. Within the factors identified, functional and shorter-term outcomes were more predictable than pain and longer-term outcomes, respectively. Regardless of their preoperative characteristics, on average, patients achieved substantial improvement in pain over time, although improvement for function was less prominent.
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Long G, Hao C, Li G, Yang Y, Hongzhong Z, Zhenhu W. Predictive value of B-type natriuretic peptide (BNP) for adverse cardiac events in patients undergoing primary total knee arthroplasty (TKA). J Orthop Sci 2016; 21:826-830. [PMID: 27623045 DOI: 10.1016/j.jos.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/24/2016] [Accepted: 08/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a well-known biomarker to predict cardiac events following orthopedic procedures. However, further information regarding BNP can be completed. The present study aims to determine which of preoperative, postoperative or the difference between them (DVPPB) can best predict adverse cardiac events following TKA procedure and detect possible risk factors of high level of BNP. METHODS Between Jan. 2012 and Jan. 2014. 1120 included patients in 3 institutions have a minimum of 2-years follow-up. All clinical characteristics related to TKA procedure were put in total joint arthroplasty registry system and analyzed finally. The cut-off value of BNP predicting patients at increased risks of cardiac events after TKA was evaluated by the Receiver Operating Characteristic (ROC) curve analysis. RESULTS Our results reveal DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TKA, and the optimal cut-off value was 825.5 pg/ml with the highest Youden index of 0.62. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. CONCLUSIONS DVPPB in comparison to preoperative and postoperative BNP can best predict cardiac events following primary TKA. Cigarette smoking, ASA III/IV/V, prior history of cardiac events, general anesthesia, surgery time, and tourniquet time are risk factors for DVPPB > 825.5 pg/ml. We hope these results could be helpful to optimize health care among patients undergoing primary TKA.
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Affiliation(s)
- Gong Long
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Chen Hao
- Department of Cardiology, Men Tou Gou District Hospital, Beijing, 100000, China
| | - Geng Li
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Yu Yang
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China
| | - Zhou Hongzhong
- Department of Orthopedics, Affiliated Hospital of Dezhou City, No.1766 San Ba Middle Road, Dezhou, Shandong, 253000, China.
| | - Wang Zhenhu
- Department of Orthopedics, 252 Hospital of Chinese PLA, Baihua East Road, Baoding, Hebei, 071000, China.
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Buirs LD, Van Beers LWAH, Scholtes VAB, Pastoors T, Sprague S, Poolman RW. Predictors of physical functioning after total hip arthroplasty: a systematic review. BMJ Open 2016; 6:e010725. [PMID: 27601486 PMCID: PMC5020746 DOI: 10.1136/bmjopen-2015-010725] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this systematic review of the literature was to identify the predictors of functional outcome after total hip arthroplasty (THA). METHOD A systematic literature search in Web of Science, CINAHL, EMBASE and PubMed was conducted on 23 June 2015. The articles were selected based on their quality, relevance and measurement of the predictive factor. The level of evidence of all studies was determined using the GRADE rating scheme. RESULTS The initial search resulted in 1092 citations. After application of the inclusion and exclusion criteria, 33 articles met our eligibility criteria and were graded. Included studies were classified as level of evidence low (11), moderate (17) or high (5). Of the included studies, 18 evaluated body mass index (BMI), 17 evaluated preoperative physical functions, 15 evaluated age, 15 evaluated gender and 13 evaluated comorbidity. There was strong evidence suggesting an association between BMI, age, comorbidity, preoperative physical functions and mental health with functional outcome after THA. There was weak evidence suggesting an association between quadriceps strength and education with functional outcome after THA. The evidence was inconsistent for associations with gender and socioeconomic status and functional outcome following THA. We found limited evidence suggesting that alcohol consumption, vitamin D insufficiency and allergies were predictors of functional outcome following THA. CONCLUSIONS We have identified multiple predictors of functional outcome after THA, which will enable general practitioners and orthopaedic surgeons to better predict the improvement in physical functioning for their patients with THA. They can use this information to provide patient-specific advice regarding the referral for THA and the expected outcomes after THA. Further research with consistent measurement tools, outcomes and duration of follow-up across studies is needed to confirm the influence of these factors.
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Affiliation(s)
- L D Buirs
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - L W A H Van Beers
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - V A B Scholtes
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - T Pastoors
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - S Sprague
- Division of Orthopedic Surgery, Department of Surgery, Centre for Evidence-Based Orthopedics, McMaster University, Hamilton, Ontario, Canada
| | - R W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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Dowsey MM, Spelman T, Choong PFM. Development of a Prognostic Nomogram for Predicting the Probability of Nonresponse to Total Knee Arthroplasty 1 Year After Surgery. J Arthroplasty 2016; 31:1654-60. [PMID: 26935945 DOI: 10.1016/j.arth.2016.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Indications for total knee arthroplasty (TKA) currently depend on clinical judgment. Up to one fifth of those who undergo primary TKA do not report a clinically meaningful improvement in pain and function after surgery. Our aim was to develop and internally validate a prognostic tool for predicting the probability of nonresponse to surgery at 12 months. METHODS Patients from 1 center who underwent primary TKA (N = 615) between 2012 and 2013. The Western Ontario and McMaster Universities Arthritis Index was collected pre- and 12 months after TKA from which nonresponse to surgery was determined using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria. Using independent prognostic correlates of postoperative nonresponse observed in adjusted modeling, we derived a prognostic nomogram to estimate the probability of nonresponse to TKA based on this suite of explanatory variables. RESULTS A total of 90/615 (15%) cases were nonresponders to TKA. The degree of contribution (odds ratio, 95% confidence interval) of each explanatory factor to nonresponse nomogram points was body mass index ≥40 kg/m(2) (3.48; 1.97-6.12), Kellgren and Lawrence <4 (2.59; 1.58-4.24), mental disability on Short Form Health Survey (SF-12) mental component score (3.30; 1.44-7.58), and every 10-point increase in preoperative Western Ontario and McMaster Universities Arthritis Index score (0.81; 0.68-0.97). The concordance index for this model was 0.74. CONCLUSION We have created a prognostic nomogram that displays the predictive probabilities of nonresponse to TKA as a source of decision support for clinicians and patients, about their likely functional outcome from TKA. Although our own internal validation suggested good nomogram performance, external validation in a comparable surgical population is required to confirm generalizability of the nomogram.
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Affiliation(s)
- Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tim Spelman
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Peter F M Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Schache MB, McClelland JA, Webster KE. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial. BMC Musculoskelet Disord 2016; 17:259. [PMID: 27295978 PMCID: PMC4906815 DOI: 10.1186/s12891-016-1104-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/27/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures. METHODS/DESIGN This protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation. DISCUSSION The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty. TRIAL REGISTRATION The trial protocol was registered with the Australian Clinical Trial Registry ( ACTRN12615000863538 ) on 18 August 2015.
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Affiliation(s)
- Margaret B Schache
- School of Allied Health, La Trobe University, Melbourne, Australia. .,Physiotherapy Department, Donvale Rehabilitation Hospital, Ramsay Health Care, 1119 Doncaster Rd, Donvale, Melbourne, 3111, Australia.
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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Bin Abd Razak HR, Tan CS, Chen YJD, Pang HN, Tay KJD, Chin PL, Chia SL, Lo NN, Yeo SJ. Age and Preoperative Knee Society Score Are Significant Predictors of Outcomes Among Asians Following Total Knee Arthroplasty. J Bone Joint Surg Am 2016; 98:735-41. [PMID: 27147686 DOI: 10.2106/jbjs.15.00280] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ability to predict patients' functional outcomes will add value to preoperative counseling. The purpose of this study was to evaluate predictors of good outcomes following total knee arthroplasty (TKA) among Asian patients. METHODS Registry data from 2006 to 2010 were extracted. The Oxford Knee Score (OKS) and the Short Form (SF)-36 physical component summary (PCS) were used to evaluate outcomes. A "good outcome" was defined as an improvement in scores of greater than or equal to the minimal clinically important difference (MCID) in the primary analysis. The MCID for the OKS was 5, and the MCID for the PCS was 10. For the sensitivity analyses, a "good outcome" was defined as an OKS of <30 and a PCS score of >50. Clinical variables were used to develop a multiple logistic regression model for a good outcome following total knee arthroplasty at 5 years. RESULTS Follow-up data were available for 3,062 patients who underwent primary TKA (mean age of 66.4 years; 79.5% female). Eighty-five percent had a good outcome on the basis of the OKS and 83%, on the basis of the SF-36 PCS. Age and preoperative Knee Society score (KSS) were found to be significant predictors. When outcomes were assessed by the MCID, lesser age and lower (worse) preoperative KSS predicted a good outcome at 5 years. When outcomes were assessed by absolute criteria (postoperative scores measured against OKS and PCS thresholds), a higher (better) preoperative KSS predicted a good outcome at 5 years. Body mass index, preoperative flexion range, SF-36 mental component summary (MCS) score, mechanical alignment, sex, education level, ethnicity, operative side, number of comorbidities, type of anesthesia, and type of implant were found not to be significant predictors. CONCLUSIONS The majority of Asian patients with osteoarthritis had good outcomes according to the MCID criterion and benefitted from primary TKA. On the basis of our findings, we believe that older patients with a lower (worse) preoperative KSS can be informed that they have a high likelihood of improvement but a lower likelihood of achieving as good a functional outcome as those with better scores. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Pak-Lin Chin
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Wukich DK, Sambenedetto TL, Mota NM, Suder NC, Rosario BL. Correlation of SF-36 and SF-12 Component Scores in Patients With Diabetic Foot Disease. J Foot Ankle Surg 2016; 55:693-6. [PMID: 27052155 PMCID: PMC5664160 DOI: 10.1053/j.jfas.2015.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Indexed: 02/03/2023]
Abstract
The assessment of patient outcomes is becoming increasingly important in all areas of medicine, including foot and ankle surgery. The Medical Outcomes Study Short Form 36-item (SF-36) is widely used as a generic measure of quality of life; however, patients often find answering 36 questions cumbersome. Consequently, the Short Form 12 (SF-12) was developed. We hypothesized that the agreement between the SF-12 and SF-36 component scores would be substantial in patients with diabetic foot disease. We retrospectively reviewed the data from 300 patients with diabetes mellitus (DM) and foot and ankle pathology who completed the SF-36 questionnaire. Of the 300 patients, 155 (51.7%) had problems directly related to complications of DM and 145 (48.3%) had routine foot complaints that were unrelated to complications of DM. The 12 questions of the SF-12 were abstracted from the SF-36. The overall median score for the SF-36 physical component summary was 34.70 compared with the overall SF-12 physical component summary of 36.75 (p = .04). The intraclass correlation coefficient was 0.93688. The overall median score for the SF-36 mental component summary was 52.40 compared with the overall SF-12 mental component summary of 51.25 (p = .34). The intraclass correlation coefficient was 0.95449. Substantial agreement was observed when comparing the component scores of the SF-12 and the SF-36. From our study results of 300 patients with DM, it appears that the SF-36 and SF-12 are comparable outcome instruments for use with patients with diabetic foot disease.
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Affiliation(s)
- Dane K. Wukich
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA,University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Tresa L. Sambenedetto
- University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Natalie M. Mota
- University of Pittsburgh Medical Center Mercy Amputation Prevention Center, Pittsburgh, PA
| | - Natalie C. Suder
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Bedda L. Rosario
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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41
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Dowsey MM, Smith AJ, Choong PFM. Latent Class Growth Analysis predicts long term pain and function trajectories in total knee arthroplasty: a study of 689 patients. Osteoarthritis Cartilage 2015; 23:2141-2149. [PMID: 26187575 DOI: 10.1016/j.joca.2015.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize groups of subjects according to their trajectory of knee pain and function over 1 to 5 years post total knee arthroplasty (TKA). METHODS Patients from one centre who underwent primary TKA (N = 689) between 2006 and 2008. The Knee Society Score (KSS) was collected pre-operatively and annually post-operatively. Latent Class Growth Analysis (LCGA) was used to classify groups of subjects according to their trajectory of knee pain and function over 1-5 years post-surgery. RESULTS LCGA identified a class of patients with persistent moderate knee pain (22.0%). Predictors (OR, 95% CI) of moderate pain trajectory class membership were pre-surgery SF12 mental component summary (MCS) per 10 points (0.65, 0.54-0.79) and physical component summary (PCS) per 10 points (0.50, 0.33-0.76), Charlson Comorbidity Index (CCI) one (1.70, 1.07-2.69) and ≥two (2.82, 1.59-4.81) and the absence of computer-navigation (2.26, 1.09-4.68). LCGA also identified a class of patients with poor function (23.0%). Predictors of low function trajectory class membership were, female sex (3.31, 1.95-5.63), advancing age per 10 years (2.27, 1.69-3.02), pre-surgery PCS per 10 points (0.50, 0.33-0.74), obesity (1.69, 1.05-2.72), morbid obesity (3.12, 1.55-6.27) and CCI ≥two (2.50, 1.41-4.42). CONCLUSIONS Modifiable predictors of poor response to TKA included baseline co-morbidity, physical and mental well-being and obesity. This provides useful information for clinicians in terms of informing patients of the expected course of longer term outcomes of TKA and for developing prediction algorithms that identify patients in whom there is a high likelihood of poor surgical response.
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Affiliation(s)
- M M Dowsey
- Department of Orthopaedics and The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Australia.
| | - A J Smith
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia.
| | - P F M Choong
- Department of Orthopaedics and The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Australia.
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42
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Maradit Kremers H, Kremers WK, Berry DJ, Lewallen DG. Social and Behavioral Factors in Total Knee and Hip Arthroplasty. J Arthroplasty 2015; 30:1852-4. [PMID: 25971779 DOI: 10.1016/j.arth.2015.04.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 02/01/2023] Open
Abstract
Social and behavioral factors are important determinants of health outcomes in a number of medical conditions but their role in joint arthroplasty is poorly understood. In a cohort of 20,124 hip and knee arthroplasty procedures, smoking was associated with a significantly higher risk of surgical site infections (hazard ratio 1.7, 95% CI: 1.1-2.6), whereas alcohol use was associated with a lower risk of reoperations and revisions (hazard ratio 0.7, 95% CI: 0.5-0.8). There was no association between marital status and educational attainment with the risk of complications or reoperations in total hip and knee arthroplasty.
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Affiliation(s)
- Hilal Maradit Kremers
- Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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43
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Günther KP, Haase E, Lange T, Kopkow C, Schmitt J, Jeszenszky C, Balck F, Lützner J, Hartmann A, Lippmann M. [Personality and comorbidity: are there "difficult patients" in hip arthroplasty?]. DER ORTHOPADE 2015; 44:555-65. [PMID: 25925089 DOI: 10.1007/s00132-015-3097-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Concomitant disorders at the time of surgery in addition to psychological and socioeconomic patient characteristics may influence treatment outcomes in hip arthroplasty. OBJECTIVES To describe the impact of these factors on perioperative complications and postoperative results in terms of function, quality of life, and patient satisfaction. MATERIALS AND METHODS Review of relevant clinical studies, meta-analyses, and presentation of our own results. RESULTS Comorbidities in general, especially in combination, increase the perioperative risk profile. Socioeconomic factors (education, professional qualifications, social deprivation) in addition to psychological variables (depression, distressed personality) can have a major impact on postoperative functional outcomes and patient satisfaction. CONCLUSIONS It is of crucial importance to avoid inequalities in the provision of joint replacement for patients with hip osteoarthritis and co-existing risk factors. Preventive strategies should be implemented to reduce the negative impact of comorbidities on treatment outcome. Personalized communication and education may be helpful in avoiding unrealistic patient expectations before hip replacement.
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Affiliation(s)
- K-P Günther
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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