Comparative analysis of total knee arthroplasty in two health care delivery systems

Heck, David A.; Maár, D; Lowdermilk, Gregory A.; Kalasinski, Lorrie A.; Meško, Jozef

doi:10.1016/0883-5403(92)90038-r

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…These differences may be due to more severe contralateral hip/knee arthritis, more severe medical comorbidity, higher prevalence of unmeasured comorbidity (renal failure, post-traumatic stress disorder, alcohol use, or metabolic syndrome), and higher complication rate and reduced knee range of motion post-TKA in veterans compared to civilians [12]. Regardless of the underlying cause of these severe ADL limitations, arthroplasty status in veterans is a surrogate for high risk for dependence in activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies have assessed functional and health outcomes at a population level [10, 11] or in high-risk groups such as veterans [6, 12]. To our knowledge, none of the published studies have assessed functional or activities of daily living (ADL) limitation in a population-based veteran sample.…”

Section: Introductionmentioning

confidence: 99%

“…Australian veterans had lower preoperative knee function score than their civilian counterparts [6]. In a small study of US veterans, compared to civilian counterparts, despite being younger veterans had more complications, longer hospital stay and reduced knee motion up to 2-year post-TKA [12]. These studies indicate that functional outcomes in veterans are perhaps less optimal than civilians.…”

Section: Introductionmentioning

confidence: 99%

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Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty

Singh

2009

Clin Rheumatol

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The objective of this study was to compare comorbidity, functional ability, and health care utilization in veterans with total knee arthroplasty (TKA) or total hip arthroplasty (THA) versus matched control populations. A cohort of veterans using Veterans Affairs (VA) healthcare system reported limitations in six activities of daily living (ADLs; bathing, dressing, eating, walking, transferring, and using the toilet), demographics, and physician-diagnosed comorbidity. VA databases provided healthcare utilization and International Classification of Diseases-9/Common procedure terminology codes for TKA/THA. Patients were classified as: (1) primary TKA; (2) primary THA; (3) combination group (≤1 procedure); and (4) control veteran population (no THA/TKA). Multivariable regression analyses compared the risk or counts of ADL limitation and in-/out-patient visits. After multivariable adjustment, TKA, THA or combination groups had significantly higher prevalence of the following compared to veteran controls: arthritis, diabetes, or heart disease (p<0.0001 each), severe (≥3) ADL limitation (33%, 42%, 42% vs. 24%; p<0.0001), and annual hospitalization rate (24%, 19%, 26% vs. 16%, p<0.0001). Annual outpatient surgery visits were more (2.5, 2.3, 2.3 vs. 2, p=0.01) and risk of any mental health outpatient visit was lower (12%, 11%, 12% vs. 18%, p=0.0039). All ADLs, except eating, were significantly more limited in arthroplasty groups (p= 0.0009). Severe ADL limitation was more prevalent in veterans with arthroplasty than in two age-matched US cohorts: 13.4 times in ≥65 years; and 1.2-, 1.6-, and 4-fold in ≥85, 75–84, and 65–74 years. Poorer function and higher comorbidity and utilization in veterans with TKA/THA suggest that this group is appropriate for interventions targeted at improving function and decreasing utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty

Singh

2009

Clin Rheumatol

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“…We have found only one previous study from the USA that has directly compared the outcomes of joint replacement between the veteran and civilian populations 8 . Patients undergoing TKR for OA at the University Hospital and the Department of Veterans Affairs Medical Centre were compared for a variety of outcomes including the KSS.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have drawn attention to potential differences in orthopaedic disorders and treatment outcomes specific to veterans, 7–9 and it has been shown that veterans are physically worse off than nonveterans 10 . OA was ranked fifth in the assessment of the prevalence of health conditions in veterans, and it may be anticipated that this health‐care problem affects the veteran population disproportionately 10 .…”

Section: Introductionmentioning

confidence: 99%