A clinical tool for the prediction of patient-reported outcomes after knee replacement surgery

Abstract Background Patient reported outcome measures (PROMs) are increasingly being incorporated into clinical and surgical care for assessing outcomes. This study examined outcomes important to patients in their decision to have hip or knee replacement surgery, their perspectives on PROMs and shared decision-making, and factors they considered important for postoperative care. Methods A cross-sectional study employing survey methods with a stratified random sample of adult orthopedic patients who were scheduled for or recently had hip or knee replacement surgery. Results In a representative sample of 226 respondents, patients identified personalized outcomes important to them that they wanted from their surgery including the ability to walk without pain/discomfort, pain relief, and returning to an active lifestyle. They preferred a personalized outcome (54%) that they identified, compared to a PROM score, for tracking progress in their care and thought it important that their surgeon know their personal outcomes (63%). Patients also wanted to engage in shared decision-making (79%) about their post-surgical care and identified personal factors important to their aftercare, such as living alone and caring for pets. Conclusions Patients identified unique personalized outcomes they desired from their care and that they wanted their orthopedic surgeons to know about. Asking patients to identify their personalized outcomes could add value for both patients and surgeons in clinical care, facilitating more robust patient involvement in shared decision-making.

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Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme

PLoS ONE ◽

10.1371/journal.pone.0261850 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261850

Author(s):

Hasan Raza Mohammad ◽

Rachael Gooberman-Hill ◽

Antonella Delmestri ◽

John Broomfield ◽

Rita Patel ◽

...

Keyword(s):

Risk Factors ◽

Knee Replacement ◽

Patient Reported Outcomes ◽

Hospital Episode Statistics ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Replacement Surgery ◽

Patient Reported ◽

Pain Outcomes ◽

Pain State

Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

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Access to hip and knee replacement surgery in patients with chronic diseases according to patient-reported pain and functional status

BMC Health Services Research ◽

10.1186/s12913-020-05464-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bélène Podmore ◽

Andrew Hutchings ◽

Sujith Konan ◽

John Robson ◽

Jan van der Meulen

Keyword(s):

Functional Status ◽

Chronic Diseases ◽

Knee Replacement ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Patient Reported

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Oxford Scores as a Triage Tool for Lower Limb Arthroplasty Lead to Discrimination and Health Inequalities

Bulletin of The Royal College of Surgeons of England ◽

10.1308/bull.2013.95.4.1 ◽

2013 ◽

Vol 95 (4) ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

CA Robb ◽

CW McBryde ◽

SJ Caddy ◽

AM Thomas ◽

PB Pynsent

Keyword(s):

Health Inequalities ◽

Knee Replacement ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Health States ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Department Of Health ◽

Patient Reported ◽

Before And After

The NHS Outcomes Framework 2011/12 from the Department of Health states that reducing health inequalities and promoting equality is central if the NHS is to deliver health outcomes that are among the best in the world. Assessment of patient reported outcome measures (PROMS) was introduced across the NHS in April 2009 both for hip and knee replacement surgery. PROMs are applied before and after certain elective health interventions funded by the NHS. In addition to the established use in assessment of outcomes, it has been suggested that preoperative instruments might be used to assess whether referrals for elective procedures are appropriate and also to identify inequalities in heathcare. For hip and knee replacement surgery, Oxford hip and knee scores are used as the measure of pain and disability.

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