Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs

Abstract

Background Concurrent head-to-head comparisons of healthcare interventions regarding cost-utility are rare. The concept of favorable cost-effectiveness of total hip or knee arthroplasty is thus inadequately verified.Patients and methods In a trial involving several thousand patients from 10 medical specialties, 223 patients who were enrolled for hip or knee replacement surgery were asked to fill in the 15D health-related quality of life (HRQoL) survey before and after operation.Results Mean (SD) HRQoL score (on a 0-1 scale) increased in primary hip replacement patients (n = 96) from 0.81 (0.084) preoperatively to 0.86 (0.12) at 12 months (p < 0.001). In revision hip replacement (n = 24) the corresponding scores were 0.81 (0.086) and 0.82 (0.097) respectively (p = 0.4), and in knee replacement (n = 103) the scores were 0.81 (0.093) and 0.84 (0.11) respectively (p < 0.001). Of 15 health dimensions, there were statistically significant improvements in moving, usual activities, discomfort and symptoms, distress, and vitality in both primary replacement groups. Mean cost per quality-adjusted life year (QALY) gained during a 1-year period was € 6,710 for primary hip replacement, € 52,274 for revision hip replacement, and € 13,995 for primary knee replacement. Interpretation Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is twice that gained from hip replacement.

Does Concomitant Low Back Pain Affect Revision Total Knee Arthroplasty Outcomes?

“…Previous studies document patient characteristics influence overall functional recovery [12,13,15,29], including one study that suggests low back pain is a preintervention predictor of outcomes [8]. Because of the large percentage of patients reporting low back pain, we therefore (1) determined the differences in baseline SF-36, WOMAC, Knee Society scores in patients without and with back pain; (2) determined the improvement in patients without and with back pain after revision TKA; and (3) compared the speed and completeness of recovery in the two groups at 12 and 24 months.…”

Preoperative Pain Catastrophizing Predicts Pain Outcome after Knee Arthroplasty

“…Although the clinical effectiveness [42] and cost-effectiveness of knee arthroplasty have been established [45], the functional and economic impacts of persistent pain and lost function for patients with poor outcome have not been determined. One commonly attributed cause of persistent unexplained pain and poor function is psychologic distress [12,57].…”

Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey

“…Hip replacement is an effective and common treatment for people with osteoarthritis and has become a high volume surgery throughout Europe (Learmonth et al, 2007, Rasanen et al, 2007. The annual incidences in Finland, Iceland and Sweden are similar (Lohmander et al, 2006).…”