scholarly journals Revision Surgery in Total Joint Replacement Is Cost-Intensive

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Markus Weber ◽  
Tobias Renkawitz ◽  
Florian Voellner ◽  
Benjamin Craiovan ◽  
Felix Greimel ◽  
...  
Keyword(s):  
Infection Rate ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Revision Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Joint Replacements ◽  
Patient Reported ◽  
One Year

Revisions after total joint replacement increase constantly. In the current study, we analyzed clinical outcome, complication rates, and cost-effectiveness of revision arthroplasty. In a retrospective analysis of 162 revision hip and knee arthroplasties from our institutional joint registry responder rate, patient-reported outcome measures (EQ-5D, WOMAC), complication rates, and patient-individual charges in relation to reimbursement were compared with a matched control group of primary total joint replacements. Positive responder rate one year postoperatively was lower for revision arthroplasties with 72.9% than for primary arthroplasties with 90.1% (OR=0.30, 95%CI=0.18–0.59, p=0.001). Correspondingly, improvement in patient-reported outcome measures one year after surgery was lower in revision than in primary joint arthroplasty with EQ-5D 0.19±0.25 to 0.30±0.24 (p<0.001) and WOMAC 24.3±30.3 to 41.2±21.3 (p<0.001). Infection rate was higher in revision (6.8%) compared to primary replacements (0%, p=0.001). Mean charges in revision arthroplasty were 76.0% higher than in matched primary joint replacements (7110.8±2249.4$ to 4041.1±975.7$, p<0.001), whereas reimbursement was only 23.6% higher (9243.3±2258.4$ in revision and 7477.9±703.1$ in primary arthroplasty, p<0.001). Revision arthroplasty is associated with lower outcome and higher infection rate compared to primary replacements. The high financial expense of revision arthroplasty is only partly covered by a higher reimbursement.

scholarly journals Implementation of Patient-Reported Outcome Measures in U.S. Total Joint Replacement Registries

2014 ◽  
Vol 96 (suppl 1) ◽  
pp. 104-109 ◽  
Author(s):  
Patricia D. Franklin ◽  
David Lewallen ◽  
Kevin Bozic ◽  
Brian Hallstrom ◽  
William Jiranek ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

scholarly journals Orthopaedic registries: the Australian experience

2019 ◽  
Vol 4 (6) ◽  
pp. 409-415 ◽  
Author(s):  
Richard N. de Steiger ◽  
Stephen E. Graves
Keyword(s):  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Annual Reports ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Australian Experience

The Australian Orthopaedic Association National Joint Replacement Registry first began data collection on 1 September 1999 and full nationwide implementation commenced in January 2003. The purpose of the Registry is to improve the quality of care for individuals receiving joint replacement surgery. The Registry enables surgeons, academic institutions, governments and industry to request specific data that are not available in published annual reports. There is an established system for identifying prostheses with a higher than anticipated rate of revision (HTARR) which was introduced in 2004. The higher rate of revision for the ASR Hip Resurfacing System was first identified by this process in 2007. There has been a reduction in revision hip and knee replacement over the years that the Registry has been in operation, and the addition of Patient Reported Outcome Measures (PROMs) and data linkage will enable more extensive analysis of joint replacement surgery in the future. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180071

scholarly journals Patient-reported outcome measures following revision knee replacement: a review of PROM instrument utilisation and measurement properties using the COSMIN checklist

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e046169
Author(s):  
Shiraz A Sabah ◽  
Elizabeth A Hedge ◽  
Simon G F Abram ◽  
Abtin Alvand ◽  
Andrew J Price ◽  
...  
Keyword(s):  
Health Status ◽  
Knee Joint ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Measurement Properties ◽  
Knee Joint Replacement ◽  
Cosmin Checklist ◽  
Patient Reported

ObjectivesTo identify: (1) patient-reported outcome measures (PROMs) used to evaluate symptoms, health status or quality of life following discretionary revision (or re-revision) knee joint replacement, and (2) validated joint-specific PROMs, their measurement properties and quality of evidence.Design(1) Scoping review; (2) systematic review following the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist.Data sourcesMEDLINE, Embase, AMED and PsycINFO were searched from inception to 1 July 2020 using the Oxford PROM filter unlimited by publication date or language.Eligibility criteria for selecting studiesStudies reporting on the development, validation or outcome of a joint-specific PROM for revision knee joint replacement were included.Results51 studies reported PROM outcomes using eight joint-specific PROMs. 27 out of 51 studies (52.9%) were published within the last 5 years. PROM development was rated ‘inadequate’ for each of the eight PROMs studied. Validation studies were available for only three joint-specific PROMs: Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). 25 out of 27 (92.6%) measurement properties were rated insufficient, indeterminate or not assessed. The quality of supporting evidence was mostly low or very low. Each of the validated PROMs was rated ‘B’ (potential for recommendation but require further evaluation).ConclusionJoint-specific PROMs are increasingly used to report outcomes following revision knee joint replacement, but these instruments have insufficient evidence for their validity. Future research should be directed toward understanding the measurement properties of these instruments in order to inform clinical trials and observational studies evaluating the outcomes from joint-specific PROMs.

scholarly journals EndoPRIME - Prehabilitation and exercise before arthroplasty

2015 ◽  
Author(s):  
Lothar Seefried ◽  
Nicole Luksche ◽  
Michael Schneider ◽  
Franca Genest
Keyword(s):  
Physical Performance ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Current Knowledge ◽  
Postoperative Outcome ◽  
Womac Score ◽  
Patient Reported Outcome ◽  
Medical Conditions ◽  
Wide Range ◽  
Patient Reported

Over the last two decades the number of total joint replacement surgeries increased consistently. With the patient population growing older and therefore suffering from more comorbidities and total joint replacement being progressively indicated even in patients with compromised medical status, the need for preoperative optimization of medical conditions appears a promising approach to reduce perioperative risk for complication, and readmission rates, avoid prolonged functional deficiency and improve functional, objective as well as patient reported, subjective outcome following surgery. Literature addressing the question of preoperative status afflicting postoperative outcome after total joint replacement is still imprecise and inconsistent. There seems to be some data, that a worse preoperative functional status predicts worse outcome in terms of both function and pain after total joint replacement. It is still not clear, what preoperatively evaluable parameters can be modified by which kind of intervention and which measures are suitable to monitor improvement of the outcome following such interventions. Based on the hypothesis that patient reported outcome, the frequency of untoward events and functional outcome following total joint replacement can be improved by establishing an individualized concept aiming at improving medical conditions and physical performance preoperatively, the EndoPRIME Trial (ENDOprosthetic joint replacement – improving treatment by integrating Prehabilitation, Rehabilitation, Individualized Management and Education) was initiated. The trial was approved by the competent ethics committee at Wuerzburg University. The project aims at expanding current knowledge about the feasibility and potential of preoperative improvement and quantivfy respective effects on postoperative outcome after total joint replacement, The proposed study is an interventional, prospective, single-center pilot study with exploratory data analysis to evaluate the feasibility and potential of improving peri- and postoperative outcome in total joint replacement of the hip, knee and shoulder by a standardized, individually optimized treatment pathway including pre- and postoperative exercising, risk management and patient education based on a comprehensive preoperative functional assessment and expanded clinical evaluation. Study duration for each individual patient comprises 12 weeks prior to surgery and one year after surgery, i.e. individual participation will last weeks. The primary endpoint of the trial is intraindividual development of osteoarthritis-associated health-limitations as measured by the WOMAC-Score. Further objectives include Patient Reported Outcome measures, type and frequency of perioperative untoward events, and a wide range of clinical and technical assessments of physical performance. Results can be expected by the third quarter 2017.

scholarly journals EndoPRIME - Prehabilitation and exercise before arthroplasty

2015 ◽  
Author(s):  
Lothar Seefried ◽  
Nicole Luksche ◽  
Michael Schneider ◽  
Franca Genest
Keyword(s):  
Physical Performance ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Current Knowledge ◽  
Postoperative Outcome ◽  
Womac Score ◽  
Patient Reported Outcome ◽  
Medical Conditions ◽  
Wide Range ◽  
Patient Reported

Over the last two decades the number of total joint replacement surgeries increased consistently. With the patient population growing older and therefore suffering from more comorbidities and total joint replacement being progressively indicated even in patients with compromised medical status, the need for preoperative optimization of medical conditions appears a promising approach to reduce perioperative risk for complication, and readmission rates, avoid prolonged functional deficiency and improve functional, objective as well as patient reported, subjective outcome following surgery. Literature addressing the question of preoperative status afflicting postoperative outcome after total joint replacement is still imprecise and inconsistent. There seems to be some data, that a worse preoperative functional status predicts worse outcome in terms of both function and pain after total joint replacement. It is still not clear, what preoperatively evaluable parameters can be modified by which kind of intervention and which measures are suitable to monitor improvement of the outcome following such interventions. Based on the hypothesis that patient reported outcome, the frequency of untoward events and functional outcome following total joint replacement can be improved by establishing an individualized concept aiming at improving medical conditions and physical performance preoperatively, the EndoPRIME Trial (ENDOprosthetic joint replacement – improving treatment by integrating Prehabilitation, Rehabilitation, Individualized Management and Education) was initiated. The trial was approved by the competent ethics committee at Wuerzburg University. The project aims at expanding current knowledge about the feasibility and potential of preoperative improvement and quantivfy respective effects on postoperative outcome after total joint replacement, The proposed study is an interventional, prospective, single-center pilot study with exploratory data analysis to evaluate the feasibility and potential of improving peri- and postoperative outcome in total joint replacement of the hip, knee and shoulder by a standardized, individually optimized treatment pathway including pre- and postoperative exercising, risk management and patient education based on a comprehensive preoperative functional assessment and expanded clinical evaluation. Study duration for each individual patient comprises 12 weeks prior to surgery and one year after surgery, i.e. individual participation will last weeks. The primary endpoint of the trial is intraindividual development of osteoarthritis-associated health-limitations as measured by the WOMAC-Score. Further objectives include Patient Reported Outcome measures, type and frequency of perioperative untoward events, and a wide range of clinical and technical assessments of physical performance. Results can be expected by the third quarter 2017.

scholarly journals Diabetes is not associated with greater pain and worse patient-reported outcome measures one year after laminoplasty for cervical spondylotic myelopathy

2021 ◽  
Author(s):  
Kosei Nagata ◽  
Junya Miyahara ◽  
Hideki Nakamoto ◽  
Naohiro Kawamura ◽  
Yujiro Takeshita ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Cervical Spondylotic Myelopathy ◽  
Rating Scale ◽  
Short Form ◽  
Neck Disability Index ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Diabetic Group ◽  
Patient Reported ◽  
One Year

Abstract Although patients with diabetes reportedly have more peripheral neuropathy, the impacts of diabetes on postoperative recovery in pain and patient-reported outcome measures (PROMs) after laminoplasty for cervical spondylotic myelopathy (CSM) is not well characterized. The authors aimed to elucidate the effects of diabetes on neck/arm/hand/leg/foot pain and PROMs after laminoplasty CSM. The authors retrospectively reviewed 339 patients (82 with diabetes and 257 without) who underwent laminoplasty between C3 and C7 in 11 hospitals during April 2017−October 2019. Preoperative Numerical Rating Scale (NRS) scores in all five areas, the Short Form-12 Mental Component Summary, Euro quality of life 5-dimension, Neck Disability Index, and the Core Outcome Measures Index-Neck) were comparable between the groups. The between-group differences were also not significant in NRS scores and PROMs one after surgery. The change score of NRS hand pain was larger in the diabetic group than the nondiabetic group. The diabetic group showed worse preoperative score but greater improvement in the Short Form-12 Physical Component Summary than the nondiabetic group, following comparable score one year after surgery. These data indicated that the preoperative presence of diabetes, at least, did not adversely affect pain or PROMs one year after laminoplasty for CSM.

scholarly journals Total joint replacement in sub-Saharan Africa: a systematic review

2019 ◽  
Vol 49 (2) ◽  
pp. 120-128 ◽  
Author(s):  
Peter SE Davies ◽  
Simon M Graham ◽  
Sithombo Maqungo ◽  
William J Harrison
Keyword(s):  
Systematic Review ◽  
Total Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Sub Saharan Africa ◽  
Total Knee Replacements ◽  
Patient Reported ◽  
Hip Replacements ◽  
Sub Saharan

Outcomes of arthroplasty in sub-Saharan Africa are not widely reported. To our knowledge, this systematic review is the first to explore this topic. Scopus, EMBASE, Medline and PubMed databases were searched, utilising MeSH headings and Boolean search strategies. All papers from South Africa were excluded. Twelve papers reporting 606 total hip replacements (THRs) and 763 total knee replacements (TKRs) were included. Avascular necrosis was the most common indication for THR, whereas osteoarthritis was the main indication for TKR. HIV prevalence of up to 33% was seen. Improvements were seen in patient-reported outcome measures in both THR and TKR. The dislocation rate in THR was 1.6%. The deep infection rate was 1.6% for TKRs and 0.5% for THRs. Positive results were reported, with comparable complications to high-income countries. However, there is likely to be significant reporting bias and the introduction of mandatory registries would enable more accurate monitoring across the region.

scholarly journals Orthopaedic registries with patient-reported outcome measures

2019 ◽  
Vol 4 (6) ◽  
pp. 357-367 ◽  
Author(s):  
Ian Wilson ◽  
Eric Bohm ◽  
Anne Lübbeke ◽  
Stephen Lyman ◽  
Søren Overgaard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Medical Professional ◽  
Patient Reported ◽  
Measuring Outcomes ◽  
Total Knee ◽  
One Year ◽  
Value Based Care

Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080

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