The use of patient-reported outcomes after routine arthroplasty

Rolfson, Ola; Malchau, Henrik

doi:10.1302/0301-620x.97b5.35356

Cited by 34 publications

(28 citation statements)

References 37 publications

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“…We believe that these improvements are mainly caused by improved care pathways and improved pre-operative and peri-operative management. 39 Further close monitoring, analysis of the failures, and its impact on life time health risk will in our view further improve our understanding and have a potential positive impact on the outcomes. It is however possible that further gains will be depending mainly on patient selection, decision-making, and further improvements of peri-operative care, and be less reliant on implant choice.…”

Section: Discussionmentioning

confidence: 97%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

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National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio‐economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio‐economic factors, surgical factors, length‐of‐stay, mortality rate, adverse events, re‐operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all‐cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal‐on‐polyethylene. Length‐of‐stay decreased by 50%. There was a reduction in 30‐ and 90‐day mortality. Re‐operation and revision rates at 2 years are decreasing. The post‐operative PROMs improved despite the observation of worse pre‐operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re‐operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:432–442, 2018.

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Section: Discussionmentioning

confidence: 97%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

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“…Value-based payment arrangements that reward quality and efficiency of care are beneficial to both surgeons and patients. However, it is important that as physicians we lead the charge in defining precedents for proper use and implementation of PROMs, else this responsibility will fall to alternative stakeholders [10,11]. With the increase in PROMs utilization, it is prudent to develop a detailed understanding of their responsiveness to surgery such that implementation can be executed in a responsible, cost-effective, and mutually beneficial manner for all stakeholders.…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures in total joint arthroplasty: defining the optimal collection window

et al. 2020

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a b s t r a c tBackground: The purpose of this study was to determine the optimal window for collection of patientreported outcome measures (PROMs) after total joint arthroplasty (TJA). Methods: Our prospectively collected institutional joint registry was queried for patients who underwent primary, unilateral TJAs. The primary outcomes were the net changes in WOMAC, SF-12 MCS, SF-12 PCS, OHS, KSCRS, and UCLA activity rating system at 6, 12, and 24 months postoperatively. Secondary outcomes were data acquisition costs and follow-up attrition rates. Results: Eight hundred sixty-six procedures (450 total hip arthroplasties, 416 TKAs) were analyzed. A consistent plateau in all PROMs was noted by 6 months postoperativelyeexcept for SF-12 MCS which showed no significant changes at any time interval. For TKA, the percentage of overall improvement achieved by 6 months was 88.7%, 84.5%, 100%, and 90.5% for the WOMAC, SF-12 PCS, UCLA, and KSCRS, respectively. For total hip arthroplasty, these values were 92.7%, 83.5%, 88.0%, and 89.8% for WOMAC, SF-12 PCS, UCLA, and OHS, respectively. There were marginal improvements from 6 to 12 months and no improvement from 12 to 24 months. Follow-up rates at 6, 12, and 24 months were 85%, 69%, and 40%, respectively. Our institutional costs for collecting a complete data set per patient were $128, $158, and $272 for 6, 12, and 24 months, respectively. Conclusions: Most of the improvement in PROMs after primary TJA occurs within the first 6 months. In addition, limiting PROMs collection to 6 months appears to be cost-efficient owing to increased attrition rates beyond this time interval.

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“…The used PROMs in this study did not capturing changes over time due to a lack of sensitivity to change of these scores [23]. Nonetheless, PROMs remain inherently subjective, prone to an individual's interpretation and perception of function [22,24].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study a wide range of PROMs were used to measure pre-and postoperative outcome after knee arthroplasty in preselected patients following ERP or OS. PROMs are a subjective measurement of clinical outcome after arthroplasty [22]. The used PROMs in this study did not capturing changes over time due to a lack of sensitivity to change of these scores [23].…”

Section: Discussionmentioning

confidence: 99%

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

Schotanus¹,

Bemelmans²,

Kort³

2017

J Clin Trial

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Purpose: Enhanced recovery pathways after knee arthroplasty have been introduced worldwide with positive results. The present study investigated the improvements of health-related quality of life and functional outcome in patients operated for knee arthroplasty who followed an Outpatient Surgery (OS) or Enhanced Recovery (ER) pathway. Methods:We reviewed our institutional database of 361 consecutive patients undergoing knee arthroplasty (total and partial) who followed either the OS-pathway (n=94; 26.1%) or ER-pathway (n=267; 73.9%). Recorded outcomes included 4 different patient reported outcome measures (PROMs; EuroQol-5D (both index and VAS), Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index and the Pain-Numerical Rating Scale) obtained pre-and during the 3-and 12-months postoperative follow-up.Results: 93 patients (99%) in the OS-group were discharged on the day of surgery as scheduled, whereas in the ER-group 70% of the patients were discharged<3 days postoperatively. At 12-month follow-up, the EQ-5D (both index and VAS) and other PROMs improved significantly (p<0.000) within each pathway. There were no significant differences between both pathways. Conclusion:One year after knee arthroplasty, patients who were included in an Outpatient Surgery pathway had comparable quality of life and PROMs as patients operated in an Enhanced Recovery pathway. Level of evidence:Case control study, Level III.

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The use of patient-reported outcomes after routine arthroplasty

Abstract: The limitations and benefits of patient-reported outcome measures, in defining the merits of arthroplasty surgery, are discussed.

Cited by 34 publications

References 37 publications

Trends in hip replacements between 1999 and 2012 in Sweden

Trends in hip replacements between 1999 and 2012 in Sweden

Patient-reported outcome measures in total joint arthroplasty: defining the optimal collection window

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

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