The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m<sup>2</sup> or Greater

Chen, Angela T.; Bronsther, Corin I; Stanley, Elizabeth E.; Paltiel, A. David; Sullivan, James K; Collins, Jamie E.; Neogi, Tuhina; Katz, Jeffrey N.; Losina, Elena

doi:10.7326/m20-4722

Cited by 19 publications

(44 citation statements)

References 51 publications

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“…Yet our current study and the broader literature are not entirely congruent with these recommendations. For example, both our hip and knee nomograms suggest that a K-L grade < 4 is prognostic for poor response to surgery, and that BMI is only prognostic for poor pain and function outcomes in those who are morbidly obese [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Estimates for Australia now predict a rise of 276% for total hip and 208% for total knee replacements by 2030, with current (direct and indirect) costs of over $5 billion/year expected to also rise [ 3 , 4 ]. With a dissatisfaction rate of between 20 and 30% after total hip and knee replacement (TJR) surgery [ 5 ], a rate of inappropriate surgery of 20–25% [ 6 ] and the lack of uniform capture of validated and relevant outcome measures, the question is not whether these procedures are cost-effective, which they are [ 7 ], but whether how and/or when TJR is utilized may be devaluing its true impact.…”

Section: Introductionmentioning

confidence: 99%

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A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

Dowsey

Spelman

Choong

2022

JCM

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Background: Total hip replacement (THR) is a common and cost-effective procedure for end-stage osteoarthritis, but inappropriate utilization may be devaluing its true impact. The purpose of this study was to develop and test the internal validity of a prognostic algorithm for predicting the probability of non-response to THR surgery at 1 year. Methods: Analysis of outcome data extracted from an institutional registry of individuals (N = 2177) following elective THR performed between January 2012 and December 2019. OMERACT-OARSI responder criteria were applied to Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scores at pre- and 1 year post-THR, to determine non-response to surgery. Independent prognostic correlates of post-operative non-response observed in adjusted modelling were then used to develop a nomogram. Results: A total of 194 (8.9%) cases were deemed non-responders to THR. The degree of contribution (OR, 95% CI) of each explanatory factor to non-response on the nomogram was, morbid obesity (1.88, 1.16, 3.05), Kellgren–Lawrence grade <4 (1.89, 1.39, 2.56), WOMAC Global rating per 10 units (0.86, 0.79, 0.94) and the following co-morbidities: cerebrovascular disease (2.39, 1.33, 4.30), chronic pulmonary disease (1.64; 1.00, 2.71), connective tissue disease (1.99, 1.17, 3.39), diabetes (1.86, 1.26, 2.75) and liver disease (2.28, 0.99, 5.27). The concordance index for the nomogram was 0.70. Conclusion: We have developed a prognostic nomogram to calculate the probability of non-response to THR surgery. In doing so, we determined that both the probability of and predictive prognostic factors for non-response to THR differed from a previously developed nomogram for total knee replacement (TKR), confirming the benefit of designing decision support tools that are both condition and surgery site specific. Future external validation of the nomogram is required to confirm its generalisability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

Dowsey

Spelman

Choong

2022

JCM

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“…Os pacientes obesos e obesos mórbidos podem ter um risco maior de complicações perioperatórias e de longo prazo; no entanto, esses pacientes não têm opções cirúrgicas negadas, devido à sua osteoartrite frequentemente debilitante. Além disso, os dados sugerem que a ATJ em pacientes com IMC ≥40 kg/m 2 melhorou a qualidade de vida e também é custo-efetiva 5 . A perda de peso antes da cirurgia pode ajudar a reduzir o risco de infecção e outras complicações perioperatórias (por exemplo, complicações relacionadas à anestesia) e reduzir o risco de revisão cirúrgica.…”

Section: Desenvolvimentounclassified

“…Se a dor no joelho parecer desproporcional à aparência radiográfica, outras causas, como patologia da coluna e do quadril e dor referida, devem ser excluídas antes que a artroplastia seja realizada. As radiografias simples são a modalidade de imagem básica para o planejamento pré-operatório e avaliação pós-operatória após ATJ 5,6 .…”

Section: Desenvolvimentounclassified

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O manejo cirúrgico da artroplasia total de joelho

Rocha¹,

Souto²,

Azevedo³

et al. 2022

BJHR

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A artroplastia total do joelho (ATJ), é um dos procedimentos ortopédicos mais comumente realizados. A ATJ consiste na ressecção das superfícies articulares doentes do joelho, seguida de recapeamento com componentes de metal e próteses de polietileno, para o paciente devidamente selecionado, o procedimento resulta em significativo alívio da dor, bem como melhora da função e da qualidade de vida. Apesar dos benefícios potenciais da ATJ, ela geralmente é realizada de forma eletiva e só deve ser considerada após o esgotamento das terapias não cirúrgicas adequadas. A artroplastia total do joelho, consiste na ressecção das superfícies articulares doentes do joelho, seguida de recapeamento com componentes protéticos de metal e polietileno. O procedimento resulta em significativo alívio da dor, bem como melhora da função e da qualidade de vida, a indicação mais comum para ATJ é associada à osteoartrite do joelho em pacientes que não tiveram sucesso com os tratamentos não operatórios.

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Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

Kostic

Leifer

Gong

et al. 2022

Arthritis Care & Research

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Objective. Class III obesity (body mass index [BMI] ≥40 kg/m 2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m 2 , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m 2 .Methods. We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and costeffectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.Results. The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m 2 , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively.Conclusion. RYGB offers good value among knee OA patients with BMI ≥40 kg/m 2 , while LSG may provide good value among those with BMI between 35 and 41 kg/m 2 .

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The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m² or Greater

Cited by 19 publications

References 51 publications

A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

O manejo cirúrgico da artroplasia total de joelho

Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

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The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m2 or Greater

Cited by 19 publications

References 51 publications

A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement

O manejo cirúrgico da artroplasia total de joelho

Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

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The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m² or Greater