Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Preference-Based Measure in Patients Following Total Knee Arthroplasty

Elmallah, Randa K.; Cherian, Jeffrey J.; Jauregui, Julio J.; Bhowmik-Stoker, Manoshi; Beaver, Walter B.; Mont, Michael A.

doi:10.1016/j.arth.2015.01.050

Cited by 16 publications

(6 citation statements)

References 15 publications

(23 reference statements)

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“…For total hip arthroplasty, our study demonstrated an annual QALY gain of 0.25 for 3,453 patients with use of the EQ-5D index and a gain of 0.18 for 4,834 patients with use of the SF-6D index. Utility changes after primary total knee arthroplasty also have been described 13 , 14 , 16 , with gains ranging from 0.125 to 0.267 (Table VIII). For primary total knee arthroplasty, we found an annual QALY gain of 0.17 for 3,309 patients with use of the EQ-5D index and a gain of 0.14 for 4,851 patients with use of the SF-6D index.…”

Section: Discussionmentioning

confidence: 90%

“…Therefore, patient-related health factors besides arthroplasty may affect postoperative QALYs. However, QALY outcomes are known to correlate with hip and knee-specific outcome instruments 12 , 16 . Also, we were unable to exclude patients with postoperative complications, which may have negatively biased the results.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, no recent studies have comprehensively provided patient utility outcomes after both primary and revision hip and knee arthroplasty. Several studies have provided information on QALY gains after primary total hip arthroplasty 12 - 15 and primary total knee arthroplasty 13 , 14 , 16 . However, those studies included small numbers of patients and did not delineate QALY outcomes after numerous other hip and knee reconstruction procedures such as revision surgery, hip resurfacing, and partial knee arthroplasty.…”

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confidence: 99%

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Quality-Adjusted Life Years After Hip and Knee Arthroplasty

Konopka

Lee

et al. 2018

JBJS OA

104

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Background:The quality-adjusted life year (QALY) is the preferred outcome measurement for cost-effectiveness analysis in health care. QALYs measure patient health-related quality of life with use of a value between 0 and 1. Few studies have provided original data delineating QALYs after hip and knee arthroplasty. In the present study, we evaluated patient utility preoperatively and 2 years after total hip arthroplasty, hip resurfacing, revision hip arthroplasty, total knee arthroplasty, unicompartmental knee arthroplasty, and revision knee arthroplasty.Methods:A single-hospital joint registry, which enrolled patients from 2007 to 2011, was retrospectively examined for all patients who underwent primary or revision hip or knee arthroplasty and who had preoperative and 2-year postoperative Short Form-36 (SF-36), Short Form-12 (SF-12), or EuroQol 5-Dimension (EQ-5D) scores available. Patient age, body mass index (BMI), sex, American Society of Anesthesiologists (ASA) score, and Charlson Comorbidity Index were recorded. QALYs were determined from the EQ-5D index and the Short Form-6 Dimension (SF-6D) index.Results:Five thousand, four hundred and sixty-three patients underwent total hip arthroplasty, with a mean annual increase (and standard deviation) of 0.25 ± 0.2 QALY; 843 patients underwent hip resurfacing, with a mean annual increase of 0.24 ± 0.17 QALY; 5,398 patients underwent primary total knee arthroplasty, with a mean annual increase of 0.17 ± 0.19 QALY; and 240 patients underwent medial unicompartmental knee arthroplasty, with a mean annual increase of 0.16 ± 0.17 QALY. Aseptic revision arthroplasty (440 hips, 323 knees) was associated with a smaller QALY gain than primary arthroplasty. Patient age, BMI, female sex, ASA category, and higher preoperative health-related quality of life were negative predictors for QALY gain after primary arthroplasty. Forty additional hip procedures and 35 additional knee procedures were also analyzed.Conclusions:Primary hip and knee arthroplasty, on average, result in substantially increased patient quality of life. Revision hip and knee replacement result in a lower, but still positive, gain in quality of life. However, there is a considerable variation in patient outcomes across all procedures. Our results may be used to improve the certainty of future cost-effectiveness analyses of hip and knee arthroplasty.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Quality-Adjusted Life Years After Hip and Knee Arthroplasty

Konopka

Lee

et al. 2018

JBJS OA

104

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“…Following institutional review board approval, an institutional database with prospectively collected data was retrospectively queried for consecutive patients who underwent primary TKA using a RA-TKA Mako system (Stryker Corp., Kalamazoo, MI) or manual TKA technique between January 2017 and August 2018 at a large multifacility academic institution (►Fig. 1). A total of 898 patients were identified.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) has undergone a plethora of innovations and improvements over the past several decades, making it one of the most quality-of-life enhancing procedures available to patients. 1,2 However, TKA is still associated with several complications, including pain, instability, implant failure, and patient dissatisfaction. 3,4 Robotic arm-assisted TKA (RA-TKA) aims to improve postoperative functional outcomes of patients undergoing TKA.…”

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confidence: 99%

Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis

et al. 2021

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The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal–Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0–13.0] vs. 11.5 [9.5–15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.

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Durability of Clinical and Quality-of-Life Outcomes of Closed-Loop Spinal Cord Stimulation for Chronic Back and Leg Pain

et al. 2022

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IMPORTANCE Chronic pain is debilitating and profoundly affects health-related quality of life. Spinal cord stimulation (SCS) is a well-established therapy for chronic pain; however, SCS has been limited by the inability to directly measure the elicited neural response, precluding confirmation of neural activation and continuous therapy. A novel SCS system measures the evoked compound action potentials (ECAPs) to produce a real-time physiological closed-loop control system. OBJECTIVE To determine whether ECAP-controlled, closed-loop SCS is associated with better outcomes compared with fixed-output, open-loop SCS at 24 months following implant. DESIGN, SETTING, AND PARTICIPANTSThe Evoke study was a double-blind, randomized, controlled, parallel arm clinical trial with 36 months of follow-up. Participants were enrolled from February 2017 to 2018, and the study was conducted at 13 US investigation sites. SCS candidates with chronic, intractable back and leg pain refractory to conservative therapy, who consented, were screened. Key eligibility criteria included overall, back, and leg pain visual analog scale score of 60 mm or more; Oswestry Disability Index score of 41 to 80; stable pain medications; and no previous SCS. Analysis took place from October 2020 to April 2021. INTERVENTIONS ECAP-controlled, closed-loop SCS was compared with fixed-output, open-loop SCS.MAIN OUTCOMES AND MEASURES Reported here are the 24-month outcomes of the trial, which include all randomized patients in the primary and safety analyses. The primary outcome was a reduction of 50% or more in overall back and leg pain assessed at 3 and 12 months (previously published). RESULTSOf 134 randomized patients, 65 (48.5%) were female and the mean (SD) age was 55.2 (10.6) years. At 24 months, significantly more closed-loop than open-loop patients were responders (Ն50% reduction) in overall pain (53 of 67 [79.1%] in the closed-loop group; 36 of 67 [53.7%] in the open-loop group; difference, 25.4% [95% CI, 10.0%-40.8%]; P = .001). There was no difference in safety profiles between groups (difference in rate of study-related adverse events: 6.0 [95% CI, −7.8 to 19.7]). Improvements were also observed in health-related quality of life, physical and emotional functioning, and sleep, in parallel with opioid reduction or elimination. Objective neurophysiological measurements substantiated the clinical outcomes and provided evidence of activation of inhibitory pain mechanisms.CONCLUSIONS AND RELEVANCE ECAP-controlled, closed-loop SCS, which elicited a more consistent neural response, was associated with sustained superior pain relief at 24 months, consistent with the 3-and 12-month outcomes.

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Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Preference-Based Measure in Patients Following Total Knee Arthroplasty

Cited by 16 publications

References 15 publications

Quality-Adjusted Life Years After Hip and Knee Arthroplasty

Quality-Adjusted Life Years After Hip and Knee Arthroplasty

Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Durability of Clinical and Quality-of-Life Outcomes of Closed-Loop Spinal Cord Stimulation for Chronic Back and Leg Pain

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