Risk Assessment Tools Used to Predict Outcomes of Total Hip and Total Knee Arthroplasty

Konopka, Joseph F.; Hansen, Viktor; Rubash, Harry E.; Freiberg, Andrew A.

doi:10.1016/j.ocl.2015.02.004

Cited by 36 publications

(31 citation statements)

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“…The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator 11 was developed in 2013 from >1.4 million cases but fails to provide accurate risk estimations for lower-limb joint replacement 12 . Attempts to make arthroplasty-specific tools have objectively been underpowered and require external validation 13 . By analyzing complication rates over time, we aimed with this study to provide current risk estimations on the basis of a large cohort of patients, to inform recommendations for the care of high-risk groups.…”

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confidence: 99%

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Partridge

Jameson

Baker

et al. 2018

The Journal of Bone and Joint Surgery

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Background:More than 75,000 total hip replacements were performed in England and Wales in 2014, and this figure is predicted to increase. Trends in mortality and complications following total hip replacement from 2005 to 2014 were evaluated to quantify risk and to identify “at-risk” groups to better inform recommendations for patient care.Methods:Our primary analysis estimated 90-day inpatient mortality following total hip replacement using Hospital Episode Statistics data from 2005 to 2014. Secondary analyses explored 30-day rates of lower respiratory tract infection, renal failure, myocardial infarction, pulmonary embolism, deep-vein thrombosis, cerebrovascular accident, and Clostridium difficile. Hierarchical logistic regression was used to estimate population averages, adjusting for time and prognostic covariates.Results:From January 2005 to July 2014, a total of 540,623 total hip replacements were reported. The 90-day mortality rate dropped steadily, from 0.60% in 2005 to 0.15% in 2014. Reported postoperative complications (with the exception of lower respiratory tract infection and renal failure) reduced year-on-year, despite a steady rise in the average Charlson Comorbidity Index score. The 30-day rate of lower respiratory tract infection and renal failure increased from 0.54% to 0.84% and 0.21% to 1.09%, respectively. The risk of mortality was significantly higher for those who developed a lower respiratory tract infection (odds ratio [OR] = 42.3) or renal failure (OR = 36.5) than for those who developed pulmonary embolism (OR = 10.9) or deep-vein thrombosis (OR = 2.6).Conclusions:Despite a population with increasing levels of comorbidity, indicators of quality of care improved from 2005 to 2014, with the exception of the rates of lower respiratory tract infection and renal failure. Postoperative care should focus on reducing the risk of lower respiratory tract infection and renal failure, both of which increased and were strongly associated with mortality. Moreover, they appeared to occur in identifiable high-risk groups; modifications to routine care should be considered for these patients.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 99%

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Partridge

Jameson

Baker

et al. 2018

The Journal of Bone and Joint Surgery

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“…However there are have not a good risk prediction tool has been developed in an attempt to quantify the patient-speci c assessment of risk by Chinese. Numerous clinical tools have been developed to predict a variety of TJA patient outcomes, include "scoring systems, nomograms and algorithms" [15]. The nomogram model is the most effective that can realize the individualized prediction of the risk of adverse clinical events by quantifying, graphing, and visualizing the logistic regression results [16].Another reason we decided to choose the arthro-MAP nomogram to validated is because the 8 preoperative and intraoperative variables (lowest HR, EBL, blood urea nitrogen, procedure type, race, ASA score, comorbidities, and presence of fracture) can be easily get form our hospital and be generalizable widely.…”

Section: Discussionmentioning

confidence: 99%

Validation of the arthro-MAP Nomogram to Predict Major Complications after Hip and Knee Arthroplasty in Chinese Population

Tan¹,

Ge²,

Mo³

et al. 2020

Preprint

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Background A nomogram(arthro-MAP) predict major complications after Hip and Knee Arthroplasty has been establish by England people. The goal of this study is to externally validate the nomogram whether suitable for Chinese people or not. Methods A total of 414 elderly patients with Hip and Knee Arthroplasty underwent surgical treatment in the Affiliated Hospital of Guangdong Medical University from March 1, 2017 to August 31, 2019 were included into this study. Variables assessed were lowest intraoperative HR, EBL, preoperative BUN, procedure type, race, ASA score, comorbidities, presence of fracture. Receiver-operator characteristics (ROC) curve analysis, calibration (HL) and DCA were used to evaluate predictive properties of the nomogram. Results A total of 414 patients were consecutively enrolled. 47 patients (11.35%) presented a major complications after Hip and Knee Arthroplasty. The arthro-MAP nomogram presented an AUC of 0.816; 95%CI: 0.757–0.875 to predict major complications. At the calibration plot x2 = 17.13, P > 0.05, means the arthro-MAP nomogram appears to be well-calibrated in Chinese population, with predicted outcome rates closely reflecting the observed rates. Conclusions Although further studies are needed to confirm our results, the arthro-MAP nomogram was, in our experience, an excellent tool to predict major complications after Hip and Knee Arthroplasty, can be perform well in the Chinese population.

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“…Exclusion criteria include the following: (1) the patient is undergoing a THA revision, (2) a bilateral THA, or (3) THA following a fractured neck of femur, (4) had a previous THA, (5) unable to converse in written or spoken English, (6) has no access to a Web-based device, and (7) has a risk assessment and prediction tool (RAPT) score less than six. The RAPT uses pre-operative patient factors of age, gender, pre-operative ambulatory distance, use of gait aid, community support, and presence of a home caregiver to predict their need for extended care after a THA [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

An eHealth Program for Patients Undergoing a Total Hip Arthroplasty: Protocol for a Randomized Controlled Trial

Saunders¹,

Seaman²,

Ashford³

et al. 2018

JMIR Res Protoc

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BackgroundTotal hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support individualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications.ObjectiveThe aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty.MethodsOne hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled “My Hip Journey.” The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's individual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital’s perspective.ResultsEnrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019.ConclusionsThe outcomes and cost of using an eHealth program to support a patient’s recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657&isReview=true (Archived by WebCite at http://www.webcitation.org/6yzoTuggx).Registered Report IdentifierRR1-10.2196/9654

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Risk Assessment Tools Used to Predict Outcomes of Total Hip and Total Knee Arthroplasty

Cited by 36 publications

References 44 publications

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Validation of the arthro-MAP Nomogram to Predict Major Complications after Hip and Knee Arthroplasty in Chinese Population

An eHealth Program for Patients Undergoing a Total Hip Arthroplasty: Protocol for a Randomized Controlled Trial

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