Comment on article by Palazzuolo et al.: Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

2021 ◽  
Author(s):  
Hui-hui Sun ◽  
Wang-xin Liu ◽  
Zhi-cheng Pan ◽  
Wei-feng Ji
Keyword(s):  
Total Knee Arthroplasty ◽  
Life Expectancy ◽  
Knee Arthroplasty ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Total Knee ◽  
Quality Adjusted Life

scholarly journals Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

2021 ◽  
Vol 45 (3) ◽  
pp. 635-641
Author(s):  
Michele Palazzuolo ◽  
Alexander Antoniadis ◽  
Jaad Mahlouly ◽  
Julien Wegrzyn
Keyword(s):  
Total Knee Arthroplasty ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Total Knee ◽  
One Year ◽  
End Stage ◽  
Quality Adjusted Life

Abstract Purpose Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis though its risk-benefit ratio in elderly patients remains debated. This study aimed to evaluate the functional outcome, rates of complication and mortality, and quality-adjusted life years (QALY) in patients who exceeded their estimated life expectancy. Methods Ninety-seven TKA implanted in 86 patients who exceeded their estimated life expectancy at the time of TKA were prospectively included in our institutional joint registry and retrospectively analyzed. At latest follow-up, the functional outcome with the Knee Society Score (KSS), rates of complication and mortality, and QALY with utility value of EuroQol-5D score were evaluated. Results At a mean follow-up of three ± one years, the pre- to post-operative KSS improved significantly (p < 0.01). The rates of surgical and major medical complications related to TKA were 3% and 10%, respectively. The re-operation rate with readmission was 3% while no TKA was revised. The 30-day and one year mortality was 1% and 3%, respectively. The pre- to one year post-operative QALY improved significantly (p < 0.01). The cumulative QALY five years after TKA was four years. Assuming that these patients did not undergo TKA, their cumulative QALY at five years would have been only two years. Conclusion TKA is an effective procedure for the treatment of end-stage osteoarthritis in patients who exceeded their estimated life expectancy. TKA provided significant improvement in function and quality of life without adversely affecting overall morbidity and mortality. Therefore, TKA should not be contra-indicated in elderly patients based on their advanced age alone.

scholarly journals Hydrotherapy Intervention for Patients Following Total Knee Arthroplasty: A Systematic Review

2021 ◽  
Author(s):  
Youguang Zhuo ◽  
Rongguo Yu ◽  
Chunling Wu ◽  
Yiyuan Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Aquatic Therapy ◽  
Life Years ◽  
Total Knee ◽  
The Impact

Abstract Background Hydrotherapy or aquatic exercise has long been known as a source of postoperative rehabilitation proposed in routine clinical practice. However, the effect on clinical outcome as well as the optimal timing of hydrotherapy in patients undergoing total knee arthroplasty (TKA) remain unclear. The purpose of this review was to assess the influence of aquatic physiotherapy on clinical outcomes and evaluate the role of the timing of aquatic-therapy for clinical outcomes after undergoing TKA. Methods An extensive literature search was performed in Embase, PubMed, and the Cochrane Library for randomized controlled trials (RCTs) that evaluated the impact of hydrotherapy on patients after TKA. The methodological quality of the trials was evaluated based on the Cochrane Risk of Bias Tool. Results All available studies on postoperative hydrotherapy after TKA were included. The primary endpoint was to evaluate the effect of hydrotherapy on clinical outcomes. The secondary outcome was to explore the role of the timing of aquatic therapy for clinical outcomes following TKA. Conclusion Although definitive conclusions could not be reached due to insufficient data, most studies indicated that participants benefited from aquatic-therapy in muscle strength, rather than gait speed, after TKA. Currently available data demonstrated that early postoperative hydrotherapy possessed a greater potential to improve clinical outcomes in main clinical scores and quality-adjusted life years (QALYs).

scholarly journals The cost-effectiveness of computer navigation in primary total knee replacement: a scoping review

2021 ◽  
Vol 6 (3) ◽  
pp. 173-180
Author(s):  
Jason Trieu ◽  
Chris Schilling ◽  
Michelle M. Dowsey ◽  
Peter F. Choong
Keyword(s):  
Cost Effectiveness ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Computer Navigation ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Total Knee ◽  
The Cost ◽  
Primary Total Knee ◽  
Quality Adjusted Life

Despite additional costs associated with the use of computer navigation technology in total knee replacement (TKR), its impact on quality-adjusted life years following surgery has not been demonstrated. Cost-effectiveness evaluations require a balanced assessment of both quality and cost metrics. This review sought to evaluate the cost-effectiveness of computer navigation, identify barriers to translation, and suggest directions for further investigation. A systematic search of the Cost-Effectiveness Analysis Registry, PubMed, and Embase was undertaken. Cost-effectiveness analyses of computer navigation in primary total knee replacement were identified. Only primary studies of cost-effectiveness analyses published in the English language from the year 2000 onwards were included. Studies that reported secondary data were excluded from the analysis. Four publications met the inclusion criteria. Estimated gains in quality-adjusted life years attributed to reductions in revision surgery were 0.0148 to 0.0164 over 10 years, and 0.0192 (95% CI –0.002 to 0.0473) over 15 years. Cost estimates ranged from 952 kr (US $90, 2020) per case at 250 TKRs/year, to $1,920 US per case at 25 TKRs/year. The estimated probability of meeting local cost-effectiveness thresholds was 54% in the United States and 92% in the United Kingdom. These data were not available for Norway. The cost-effectiveness of computer navigation in current practice settings remains uncertain, with the use of this technology associated with marginal increased quality-adjusted life years (QALYs) at additional cost. Existing analyses demonstrated a number of limitations which restrict the potential for translation to practice and policy settings. Further research evaluating the impact of computer navigation on QALYs following primary TKR is required to inform contemporary cost-effectiveness evaluations. Cite this article: EFORT Open Rev 2021;6:173-180. DOI: 10.1302/2058-5241.6.200073

scholarly journals Life expectancy of osteoarthritic patients after primary total knee arthroplasty

2017 ◽  
Vol 8 ◽  
pp. S57-S61 ◽  
Author(s):  
Yoshinori Ishii ◽  
Hideo Noguchi ◽  
Junko Sato ◽  
Hana Ishii ◽  
Satoshi Takayama ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Life Expectancy ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals Impact of overweight and obesity on life expectancy, quality-adjusted life years and lifetime costs in the adult population of Ghana

2020 ◽  
Vol 5 (9) ◽  
pp. e003332
Author(s):  
Stella Lartey ◽  
Lei Si ◽  
Thomas Lung ◽  
Costan G Magnussen ◽  
Godfred O Boateng ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Adult Population ◽  
Overweight And Obesity ◽  
Sub Saharan Africa ◽  
Adult Health ◽  
Healthy Weight ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

IntroductionPrior studies have revealed the increasing prevalence of obesity and its associated health effects among ageing adults in resource poor countries. However, no study has examined the long-term and economic impact of overweight and obesity in sub-Saharan Africa. Therefore, we quantified the long-term impact of overweight and obesity on life expectancy (LE), quality-adjusted life years (QALYs) and total direct healthcare costs.MethodsA Markov simulation model projected health and economic outcomes associated with three categories of body mass index (BMI): healthy weight (18.5≤BMI <25.0); overweight (25.0≤BMI < 30.0) and obese (BMI ≥30.0 kg/m2) in simulated adult cohorts over a 50-year time horizon from age fifty. Costs were estimated from government and patient perspectives, discounted 3% annually and reported in 2017 US$. Mortality rates from Ghanaian lifetables were adjusted by BMI-specific all-cause mortality HRs. Published input data were used from the 2014/2015 Ghana WHO Study on global AGEing and adult health data. Internal and external validity were assessed.ResultsFrom age 50 years, average (95% CI) remaining LE for females were 25.6 (95% CI: 25.4 to 25.8), 23.5 (95% CI: 23.3 to 23.7) and 21.3 (95% CI: 19.6 to 21.8) for healthy weight, overweight and obesity, respectively. In males, remaining LE were healthy weight (23.0; 95% CI: 22.8 to 23.2), overweight (20.7; 95% CI: 20.5 to 20.9) and obesity (17.6; 95% CI: 17.5 to 17.8). In females, QALYs for healthy weight were 23.0 (95% CI: 22.8 to 23.2), overweight, 21.0 (95% CI: 20.8 to 21.2) and obesity, 19.0 (95% CI: 18.8 to 19.7). The discounted total costs per female were US$619 (95% CI: 616 to 622), US$1298 (95% CI: 1290 to 1306) and US$2057 (95% CI: 2043 to 2071) for healthy weight, overweight and obesity, respectively. QALYs and costs were lower in males.ConclusionOverweight and obesity have substantial health and economic impacts, hence the urgent need for cost-effective preventive strategies in the Ghanaian population.

scholarly journals Quality-Adjusted Life Years After Hip and Knee Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. e0007 ◽  
Author(s):  
Joseph F. Konopka ◽  
Yuo-yu Lee ◽  
Edwin P. Su ◽  
Alexander S. McLawhorn
Keyword(s):  
Knee Arthroplasty ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Hip And Knee Arthroplasty ◽  
Quality Adjusted Life
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