Prevalence of Clinically Significant Improvement Following Total Knee Replacement (original) (raw)
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Total knee replacement; minimal clinically important differences and responders
Osteoarthritis and Cartilage, 2013
Objective: To provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis Index (WOMAC) in patients who have undergone total knee replacement (TKR). Methods: 1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0e100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cutoff values. Results: Global MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cutoff values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function. Conclusion: Due to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.
A 5 year prospective study of patient-relevant outcomes after total knee replacement
Osteoarthritis and Cartilage, 2009
Objective: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). Methods: 102 consecutive patients with knee OA, 63 women and 39 men, mean age 71 (51e86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years postoperatively. Results: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P < 0.001). The percentage of patients performing more demanding functions related to sports and recreation increased postoperatively. The best postoperative result was reported at the 1 year follow-up. Compared to the 1 year follow-up, a significant (P 0.01) decline was seen at 5 years in the KOOS subscale activity of daily living (ADL) function (82e73) and the SF-36 subscale bodily pain (72e63), PF (61e51) and vitality (69e59). Patients who scored in the lowest quartile preoperatively in the KOOS subscales pain and ADL made the greatest improvements to 1 year (18e82, 22e80) but also declined the most from 12 months to 5 years (82e72, 80e66). Being 10 years older pre-operatively predicted 5e7 points worse scores in KOOS pain and KOOS symptoms at 1 and 5 years. When adjusted for age, sex and comorbid conditions, pre-operative SF-36 scores did not predict postoperative KOOS pain or PF scores. Conclusion: Compared to preoperatively, a significant improvement was still seen 5 years postoperatively. However, the best result was reported at 1 year, indicating a decline from 1 to 5 years after TKR. To fully evaluate the results of TKR with regard to pain and PF, follow-ups longer than 2 years are needed, and items of more demanding PFs should be included. Older age to some extent predicted more postoperative pain and other symptoms, however, no predictors of postoperative PF were found, indicating the difficulty of determining preoperatively who will benefit more or less from the procedure.
Assessing and improving outcomes: total knee replacement
Health Services Research
Over the past two decades, total knee replacement (TKR) has become an increasingly used therapy to reduce pain and improve functional status among patients with severe arthritis of the knee. The number of TKRs performed annually in this country has risen from less than 10,000 in 1975 to a projected 150,000 in 1990. Outcomes from the procedure as performed in academic medical centers have been widely reported; however, the extent to which TKRs are performed and the outcomes from TKR care in community hospitals have not been documented. In addition, despite acceptance of TKR as a management strategy among both patients and health care providers, a series of important questions regarding the relative benefits, risks, and associated costs of the procedure in comparison to alternative management strategies remain unanswered.
Effect of patient characteristics on reported outcomes after total knee replacement
Rheumatology, 2007
Objective. To evaluate the effect of pre-intervention factors in patient-reported outcomes at 6 months post-operatively following total knee replacement. Methods. A prospective observational study was carried out using two questionnaires sent to patients while they were on the waiting list for surgery: a generic questionnaire, the Medical Outcomes Study Short Form-36 (SF-36), and a specific questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Six months after intervention, patients again received the same questionnaires. The dependent variables were the scores of the three domains of the WOMAC and the eight domains of the SF-36. Results. We recruited 640 patients. The mean age was 71 yrs and 73.6% of the patients were females. The multivariate analysis, in which the pre-intervention scores for each domain were added as covariates, showed that the most significant pre-intervention predictors were the baseline scores of each domain. Besides that, the social support, low back pain and the baseline score of the mental health domain (SF-36) were the pre-intervention predictors in the three WOMAC domains. With regard to the SF-36 domains the main predictors were the baseline mental health score, comorbidities, low back pain and social support. Conclusions. The main predictor of outcome at 6 months post-operatively in all eleven domains was the pre-intervention score of each domain. Presence of social support, absence of low back pain and higher baseline SF-36 mental health score were related to the improvement in the health-related quality of life post-operatively. by guest on April 12, 2014 http://rheumatology.oxfordjournals.org/ Downloaded from Rheumatology Key messages The pre-intervention score is the strongest determinant of the post-operative scores at 6 months in each domain. The presence of social support, absence of low back pain and the preintervention score of the MH domain of the SF-36 are good predictors Effect on patient-reported outcomes after total knee replacement 7 of 8 by guest on April 12, 2014 http://rheumatology.oxfordjournals.org/ Downloaded from
Predictors of outcomes of total knee replacement surgery
Rheumatology (Oxford, England), 2012
To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than ...
International Journal of Research in Orthopaedics, 2016
The surgical techniques has varied from soft tissue interposition arthroplasty to resection arthroplasty to surface replacement arthroplasty. In surface replacement arthroplasty different types of prosthesis were developed to address the complex knee kinematics. Total knee arthroplasty (TKA) is now a reliable treatment for severe arthritis. Various systems are available with ABSTRACT Background: Total knee arthroplasty (TKA) is now a reliable treatment for osteoarthritis. The aim of this study was to study the clinical and functional outcome of total knee arthroplasty using knee society score and to find association between knee functional score and knee clinical score. Methods: We conducted a prospective analysis of 40 cases of osteoarthritis knee patients at a tertiary care centre in Mumbai over a period of two years. Those patients who underwent total knee arthroplasty were assessed clinically and functionally using knee society score. Results: The mean preoperative knee clinical score (KCS) was 49.40±13.79 which was increased to a postoperative score of 86.08±5.64 at the end of 6 month. Similarly the mean preoperative knee functional score (KFS) was 32.75±11.79 which was increased to a postoperative score of 84.43±9.59 at the end of 6 month. There was significant increase in KCS and KFC score during follow up at 1, 3 and 6 month interval. There was significant association between knee functional score and knee clinical score at every interval. Conclusions: Total knee arthroplasty improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op knee clinical score and knee functional score.
Background: Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre-and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA. Methods: 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects' medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores.
Comparison of patient-reported outcome measures following total and unicondylar knee replacement
The Journal of Bone and Joint Surgery. British volume, 2012
Following arthroplasty of the knee, the patient’s perception of improvement in symptoms is fundamental to the assessment of outcome. Better clinical outcome may offset the inferior survival observed for some types of implant. By examining linked National Joint Registry (NJR) and patient-reported outcome measures (PROMs) data, we aimed to compare PROMs collected at a minimum of six months post-operatively for total (TKR: n = 23 393) and unicondylar knee replacements (UKR: n = 505). Improvements in knee-specific (Oxford knee score, OKS) and generic (EuroQol, EQ-5D) scores were compared and adjusted for case-mix differences using multiple regression. Whereas the improvements in the OKS and EQ-5D were significantly greater for TKR than for UKR, once adjustments were made for case-mix differences and pre-operative score, the improvements in the two scores were not significantly different. The adjusted mean differences in the improvement of OKS and EQ-5D were 0.0 (95% confidence interval ...
BMC sports science, medicine and rehabilitation, 2013
Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA. 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects' medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regr...
BMJ Open, 2021
ObjectiveTo assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA).DesignProspective cohort study.SettingTwo provincial central intake hip and knee centres in Alberta, Canada.Participants1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA.Primary and secondary outcome measuresPre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA.ResultsMean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least ...