Qualidade de vida após artroplastia total do joelho: revisão sistemática

Silva, Robson Rocha da; Santos, Ayrton André Melo; Júnior, José de Sampaio Carvalho; Matos, Marcos Almeida

doi:10.1016/j.rbo.2013.10.023

Cited by 60 publications

(14 citation statements)

References 40 publications

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“…The trial population predominantly included patients with severe preoperative symptoms, as shown by low mean quality of life utility values at baseline 7. Many previously published uncontrolled before-after studies showed similarly large effects 89 In particular, the systematic review by Shan and colleagues described 19 studies that showed substantial improvements from baseline status, both in the intermediate and long term, for disease specific and generic health related quality of life across a broad range of domains 9.…”

Section: Introductionmentioning

confidence: 99%

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

Ferket

Feldman

Oei

et al. 2017

BMJ

138

126

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ObjeCtivesTo evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms. DesignMarginal structural modeling and cost effectiveness analysis based on lifetime predictions for total knee replacement and death from population based cohort data.setting Data from two studies-Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)-within the US health system. PartiCiPants 4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous knee replacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up.interventiOn Scenarios ranging from current practice, defined as total knee replacement practice as performed in the OAI (with procedural rates estimated by a prediction model), to practice limited to patients with severe symptoms to no surgery. Main OutCOMe MeasuresGeneric (SF-12) and osteoarthritis specific quality of life measured over 96 months, model based QALYs, costs, and incremental cost effectiveness ratios over a lifetime horizon. resultsIn the OAI, total knee replacement showed improvements in quality of life with small absolute changes when averaged across levels of confounding variables: 1.70 (95% uncertainty interval 0.26 to 3.57) for SF-12 physical component summary (PCS); −10.69 (−13.39 to −8.01) for Western Ontario and McMaster Universities arthritis index (WOMAC); and 9.16 (6.35 to 12.49) for knee injury and osteoarthritis outcome score (KOOS) quality of life subscale. These improvements became larger with decreasing functional status at baseline. Provision of total knee replacement to patients with SF-12 PCS scores <35 was the optimal scenario given a cost effectiveness threshold of $200 000/QALY, with cost savings of $6974 ($5789 to $8269) and a minimal loss of 0.008 (−0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY. COnClusiOn Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use.

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Section: Introductionmentioning

confidence: 99%

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

Ferket

Feldman

Oei

et al. 2017

BMJ

138

126

View full text Add to dashboard Cite

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“…Total knee arthroplasty (TKA) provides a significant improvement in the quality of life for knee osteoarthritis patients [3,4,5]. As life expectancy and activity levels in the elderly increase in industrialised countries, TKA is becoming even more popular [6].…”

Section: Introductionmentioning

confidence: 99%

Validation of a Novel Device for the Knee Monitoring of Orthopaedic Patients

Kayaalp

Agres

Reichmann

et al. 2019

Sensors

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Fast-track surgery is becoming increasingly popular, whereas the monitoring of postoperative rehabilitation remains a matter of considerable debate. The aim of this study was to validate a newly developed wearable system intended to monitor knee function and mobility. A sensor system with a nine-degree-of-freedom (DOF) inertial measurement unit (IMU) was developed. Thirteen healthy volunteers performed five 10-meter walking trials with simultaneous sensor and motion capture data collection. The obtained kinematic waveforms were analysed using root mean square error (RMSE) and correlation coefficient (CC) calculations. The Bland–Altman method was used for the agreement of discrete parameters consisting of peak knee angles between systems. To test the reliability, 10 other subjects with sensors walked a track of 10 metres on two consecutive days. The Pearson CC was excellent for the walking data set between both systems (r = 0.96) and very good (r = 0.95) within the sensor system. The RMSE during walking was 5.17° between systems and 6.82° within sensor measurements. No significant differences were detected between the mean values observed, except for the extension angle during the stance phase (E1). Similar results were obtained for the repeatability test. Intra-class correlation coefficients (ICCs) between systems were excellent for the flexion angle during the swing phase (F1); good for the flexion angle during the stance phase (F2) and the re-extension angle, which was calculated by subtracting the extension angle at swing phase (E2) from F2; and moderate for the extension angle during the stance phase (E1), E2 and the range of motion (ROM). ICCs within the sensor measurements were good for the ROM, F2 and re-extension, and moderate for F1, E1 and E2. The study shows that the novel sensor system can record sagittal knee kinematics during walking in healthy subjects comparable to those of a motion capture system.

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“…Total knee arthroplasty (TKA) is a widely used surgical procedure [1, 2]. In 2014, Germany’s incidence of TKA was 197 per 100,000 inhabitants, which was the second highest rate in Europe [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although TKA is generally considered cost-effective [3, 4] and improved function, mobility and quality of life [1, 3, 5, 6], a subset of patients report prolonged pain, functional impairment [7] or remain dissatisfied with outcomes [8–12].…”

Section: Introductionmentioning

confidence: 99%

Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty – results from a German prospective cohort study

Felix

Becker

Vogl

et al. 2019

Health Qual Life Outcomes

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BackgroundEvaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL.MethodsBaseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation.ResultsOne hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply.Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6).ConclusionOn average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.

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Qualidade de vida após artroplastia total do joelho: revisão sistemática

Abstract: r e v b r a s o r t o p . 2 0 1 4;4 9(5):520-527 w w w . r b o . o r g . b r Artigo OriginalQualidade de vida após artroplastia total do joelho: revisão sistemática ଝ

Cited by 60 publications

References 40 publications

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

Validation of a Novel Device for the Knee Monitoring of Orthopaedic Patients

Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty – results from a German prospective cohort study

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