Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery

Lungu, Eugen; Desmeules, François; Dionne, Clermont E.; Belzile, Étienne L.; Vendittoli, Pascal‐André

doi:10.1186/1471-2474-15-299

Cited by 47 publications

(47 citation statements)

References 32 publications

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“…Hawker et al 20 noted that joint pain was the most common reason patients seeking TKA and, in contradiction to the findings of Lungu et al, 15 suggested that at a minimum, it seems reasonable that evaluation of the benefits of TKA incorporates improvement in pain. Hawker et al 20 aimed to determine the principle achievements of a 'good' outcome, defined as a clinically important improvement in pain and disability-assessed outcome using an overall measure of selfreported hip/knee pain.…”

Section: Painmentioning

confidence: 94%

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Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

2018

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It is estimated that up to a third of recipients of total knee arthroplasty (TKA) experience chronic pain postoperatively. However, there are no clear indications within the literature that predict which patients are at higher risk of being dissatisfied with their TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) is one of the most commonly used, patient-reported outcome measures in patients with lower limb osteoarthritis. This review discusses the available evidence surrounding the predictability of the outcome of TKA using the WOMAC score as well as considering further patient factors that have been implicated in the level of improvement post TKA. It may be concluded from the available literature that a combination of knee scores and patient factors would be the most accurate way of predicting those patients most likely to have a good outcome from their TKA. There is some disparity within the literature about which patient factors and reported outcome measure scores lead to a positive postoperative outcome. Patient expectations following the procedure also need to be evaluated, as objective measures on a scoring system do not necessarily equate with the subjective patient experience.

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Section: Painmentioning

confidence: 94%

“…Lungu et al 15 aimed to develop a prediction tool that would allow the early identification of patients at risk of poor outcome following primary TKA. The best predictive model developed in this study incorporated five items from the baseline WOMAC questionnaire, specifically questions regarding function and stiffness.…”

Section: Joint Factors Functionmentioning

confidence: 99%

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

2018

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“…Risk calculators, appropriateness tools and predictive models have been developed to predict clinical outcomes and revision surgery, but these instruments lack the ability to provide precise thresholds that reliably predict failure and have not been validated using external datasets . Early efforts using large administrative datasets in the United States to develop a predictive tool of 30‐day readmission rates have had some success .…”

Section: Patient Characteristics Influencing Decision Makingmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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“…The minimal difference in falls and fracture risk between people who have undergone a THA and TKA is notable from this dataset. Whilst a good recovery following THR has been widely considered to be high in this population [29], between 20% to 30% of people following TKA still present with residual pain, loss of motion and functional difficulties at 12 and 24 post-operative months [30,31]. Since these are all recognised risk factors to falls, the minimal difference between the cohorts is an interesting finding which may or may not be representable of the wider population.…”

Section: Total Knee Arthroplastymentioning

confidence: 99%

Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative

Smith

Pearson

Latham

2016

Arch Orthop Trauma Surg

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Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery

Cited by 47 publications

References 32 publications

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

Selecting and optimising patients for total knee arthroplasty

Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative

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