Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Liebensteiner, Michael; Wurm, Alexander; Gamper, Dennis; Oberaigner, Wilhelm; Dammerer, Dietmar; Krismer, Martin

doi:10.1007/s00264-018-4185-3

Cited by 21 publications

(17 citation statements)

References 21 publications

(36 reference statements)

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“…It has been mentioned in some studies that KL score should not be the preferred tool for assessing OA severity [9,39], as some studies question the classification's inter-rater and intra-rater reliability [29,40] and the use of differing descriptions of the grading system [29] makes it difficult to compare findings between studies. A study comparing 3 different X-ray scoring methods of knee OA concluded that joint space width evaluation on semiflexed views might be the preferred method to evaluate the severity of knee OA [39].…”

Section: Discussionmentioning

confidence: 99%

More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients’ Health State Following a Total Knee Arthroplasty

Rehman

Lindberg

Arnljot

et al. 2020

The Journal of Arthroplasty

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Background: To assess whether preoperative radiological severity of osteoarthritis (OA) is related to the level of improvement in patients' health state measured 1 year after total knee arthroplasty (TKA). Methods: Radiographic severity of OA was graded using the Kellgren-Lawrence (KL) classification. Two independent observers were blinded to patients' outcome scores. Health-related quality of life was measured using EQ-5D-3L preoperatively and at 12-month follow-up. The 5 dimensions of the EQ-5D were converted into a health state index score. The association between KL grade and improvement in health state score was analyzed using multiple linear regression. Results: Among 156 consecutive patients (68% females, mean age 69 years) who underwent primary TKA, 3 knees (2%) were classified as KL grade 2, 115 as KL grade 3 (74%), and 38 as KL grade 4 (24%). Follow-up rate was 77%. There was substantial intra-rater and inter-rater agreement (Cohen's kappa ¼ 0.80 and 0.79). Most patients (64%) had clinically significant improvement in their health state score 1 year after TKA. However, after adjusting for relevant covariates, patients with severe OA (KL grade 4) were found to have significantly more improvement in their health state score than patients with mild or moderate OA (KL grade 2 or 3, respectively). Separate analysis of the 5 EQ-5D dimensions showed that the KL group differences were most evident in the "usual activities" and "pain/discomfort" dimensions. Conclusion: Patients with severe OA have significantly more improvement in their usual activities and pain/discomfort 1 year after TKA than patients with less severe OA.

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Section: Discussionmentioning

confidence: 99%

More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients’ Health State Following a Total Knee Arthroplasty

Rehman

Lindberg

Arnljot

et al. 2020

The Journal of Arthroplasty

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“…In a long-term study on quality of life and costs in a U.S. cohort of patients followed up to eight years, quality of life improvements and cost benefits associated with surgical intervention can only be appreciated in the highest risk patients and support the necessity for early medical management [23]. Patients with preoperative complete joint space collapse (0 to 1 mm mJSW) achieve a significantly better WOMAC result from TKA than those with a mJSW equal to or greater than 2 mm [24].…”

Section: Discussionmentioning

confidence: 99%

Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

Mahendira

Jones

Papachristos

et al. 2019

International Orthopaedics (SICOT)

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Objective To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact. Methods We prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined. Results Five patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered "de facto" surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management. Conclusion These findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens. Keywords Osteoarthritis . Arthritis . Total knee arthroplasty . Multidiscplinary medical management . Health economics . Models of care . Comprehensive non-surgical management . WOMAC . Advanced clinician practitioner . Advanced practice physcial therapist Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-019-04405-y) contains supplementary material, which is available to authorized users.

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“…Total knee arthroscopy (TKA) is a common surgical intervention, in the USA, more than 600,000 patients receive TKA every year [4]. With the continuous development and improvement of surgical techniques and implants, long-term postoperative patient satisfaction can reach 80% and the survival rate of the prosthesis can exceed 95% [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The influence of posterior tibial slope on the mid-term clinical effect of medial-pivot knee prosthesis

et al. 2021

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Objective To evaluate the effect of posterior tibial slope (PTS) on the mid-term clinical outcome following a medial-pivot (MP) prosthesis. Method Two hundred thirty-three patients from The Affiliated Hospital of Qingdao University, who had undergone a total knee arthroplasty (TKA) with MP prosthesis between January 2015 and December 2015, were retrospectively included in this study. They were divided into 3 groups according to postoperative PTS: A ≤ 5°; B 5-7°; and C ≥ 7°. Multiple assessments were made on the patient postoperatively and recorded in the three groups, the measurements of this study included: the range of motion (ROM), knee scoring system (KSS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), posterior condylar offset (PCO), joint line height, and postoperative complications. Results The average post-operative ROM for groups B and C were 108° and 110° respectively; this was significantly higher than that of group A (98°, P < 0.001). The WOMAC scores of patients in group C were significantly lower than those in groups A and B (P < 0.05). However, there were no significant differences in KSS, PCO, and joint line height among the 3 groups (P > 0.05). Only 2 cases of postoperative complications occurred in group C, these were ameliorated after operation. Conclusion With an increase to PTS, the postoperative ROM can be significantly increased for the patient. However, the knee joint function will not be significantly improved, and the stability of knee joint will not be affected when within the limits of appropriate PTS.

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Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Cited by 21 publications

References 21 publications

More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients’ Health State Following a Total Knee Arthroplasty

More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients’ Health State Following a Total Knee Arthroplasty

Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

The influence of posterior tibial slope on the mid-term clinical effect of medial-pivot knee prosthesis

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