scholarly journals Patient Experiences When Preparing for Discharge Home after Total Knee Replacement

2017 ◽  
Author(s):  
Renee Causey-Upton ◽  
Dana Howell
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Care Staff ◽  
Care Providers ◽  
Discharge Home ◽  
Total Knee ◽  
Realistic Information ◽  
At Home

Purpose: Following total knee replacement (TKR), patients must prepare quickly for discharge to home via education and rehabilitation. Patient needs may not fully be met prior to discharge after TKR surgery. The purpose of this descriptive study using transcendental phenomenology methods was to understand patients’ experiences when preparing to return home after TKR surgery. Method: Data was collected using semi-structured interviews that occurred 1 to 2 days prior to discharge in patients’ hospital rooms. Four participants were interviewed prior to discharge and interviews were transcribed verbatim for data analysis. Data analysis and data collection were concurrent, permitting subsequent interviews to be altered as needed based on results from previous participants. Thematic analysis of the interview transcriptions was conducted to identify significant meaning statements through a process of horizonalization. Significant statements were organized into shared themes among participants. Results: Three themes emerged: being supported for discharge home; having confidence in self, family and health care staff; and persevering: overcoming obstacles. Participants overall felt prepared for their surgery and the post-operative phase. The following factors increased readiness for discharge: having prior positive experience with TKR through the experiences of others, attending pre-operative education, interacting with knowledgeable staff, and having the appropriate support at home. Some patients were unprepared for the amount of pain they experienced after surgery. Conclusions/Recommendations: Health care providers should educate patients about safety for the home environment, adaptive techniques for functional tasks, and when to resume normal activities at home. Other implications include encouraging patients to attend pre-operative education, addressing patients’ previous experiences with TKR, both positive and negative, as well as providing realistic information regarding pain after surgery.

scholarly journals Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT

2020 ◽  
Vol 24 (20) ◽  
pp. 1-98
Author(s):  
David J Beard ◽  
Loretta J Davies ◽  
Jonathan A Cook ◽  
Graeme MacLennan ◽  
Andrew Price ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Replacement ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Medial Compartment ◽  
Knee Score ◽  
Patient Reported ◽  
Total Knee ◽  
Partial Knee Replacement

Background Late-stage medial compartment knee osteoarthritis can be treated using total knee replacement or partial (unicompartmental) knee replacement. There is high variation in treatment choice and insufficient evidence to guide selection. Objective To assess the clinical effectiveness and cost-effectiveness of partial knee replacement compared with total knee replacement in patients with medial compartment knee osteoarthritis. The findings are intended to guide surgical decision-making for patients, surgeons and health-care providers. Design This was a randomised, multicentre, pragmatic comparative effectiveness trial that included an expertise component. The target sample size was 500 patients. A web-based randomisation system was used to allocate treatments. Setting Twenty-seven NHS hospitals (68 surgeons). Participants Patients with medial compartment knee osteoarthritis. Interventions The trial compared the overall management strategy of partial knee replacement treatment with total knee replacement treatment. No specified brand or subtype of implant was investigated. Main outcome measures The Oxford Knee Score at 5 years was the primary end point. Secondary outcomes included activity scores, global health measures, transition items, patient satisfaction (Lund Score) and complications (including reoperation, revision and composite ‘failure’ – defined by minimal Oxford Knee Score improvement and/or reoperation). Cost-effectiveness was also assessed. Results A total of 528 patients were randomised (partial knee replacement, n = 264; total knee replacement, n = 264). The follow-up primary outcome response rate at 5 years was 88% and both operations had good outcomes. There was no significant difference between groups in mean Oxford Knee Score at 5 years (difference 1.04, 95% confidence interval –0.42 to 2.50). An area under the curve analysis of the Oxford Knee Score at 5 years showed benefit in favour of partial knee replacement over total knee replacement, but the difference was within the minimal clinically important difference [mean 36.6 (standard deviation 8.3) (n = 233), mean 35.1 (standard deviation 9.1) (n = 231), respectively]. Secondary outcome measures showed consistent patterns of benefit in the direction of partial knee replacement compared with total knee replacement although most differences were small and non-significant. Patient-reported improvement (transition) and reflection (would you have the operation again?) showed statistically significant superiority for partial knee replacement only, but both of these variables could be influenced by the lack of blinding. The frequency of reoperation (including revision) by treatment received was similar for both groups: 22 out of 245 for partial knee replacement and 28 out of 269 for total knee replacement patients. Revision rates at 5 years were 10 out of 245 for partial knee replacement and 8 out of 269 for total knee replacement. There were 28 ‘failures’ of partial knee replacement and 38 ‘failures’ of total knee replacement (as defined by composite outcome). Beyond 1 year, partial knee replacement was cost-effective compared with total knee replacement, being associated with greater health benefits (measured using quality-adjusted life-years) and lower health-care costs, reflecting lower costs of the index surgery and subsequent health-care use. Limitations It was not possible to blind patients in this study and there was some non-compliance with the allocated treatment interventions. Surgeons providing partial knee replacement were relatively experienced with the procedure. Conclusions Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years. Future work Further (10-year) follow-up is in progress to assess the longer-term stability of these findings. Trial registration Current Controlled Trials ISRCTN03013488 and ClinicalTrials.gov NCT01352247. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 20. See the NIHR Journals Library website for further project information.

scholarly journals Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study (Preprint)

2017 ◽  
Author(s):  
Yasmin van Kasteren ◽  
Jill Freyne ◽  
M Sazzad Hussain
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Digital Technology ◽  
Care Delivery ◽  
Health Care Service ◽  
Hospital Length Of Stay ◽  
Patient Centered ◽  
Total Knee

BACKGROUND The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. OBJECTIVE The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. METHODS A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. CONCLUSIONS Digital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

Lack of Difference In Co-Morbidities Associated with Deep Venous Thrombosis In Patients Undergoing Total Knee Replacement

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2578-2578
Author(s):  
Prabhu Viswanathan ◽  
Upasana Tiwari ◽  
Lakshmanan Krishnamurti
Keyword(s):  
Health Care ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Care Utilization ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Deep Vein

Abstract Abstract 2578 Background: Thromboprophylaxis is the top challenge to patient safety practice in hospitals. Postoperative Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the major cardiovascular killers in the surgical setting. In October 2008, Medicare designated DVT and PE occurring after total knee or hip replacement as ‘never events', and indicated that they will not pay the incremental cost to manage the complication and has made the hospital acquired DVT/PE unacceptable and serious. There are however, limited data on factors contributing to DVT/PE in-patients undergoing total knee or hip replacement. Aim: To ascertain nationwide health care utilization and associated co-morbidities in Total knee replacement (TKR) recipients who do or do not develop DVT/PE. Methods: We used the year 2007, National Inpatient Sample (NIS) to analyze the post operative occurrence of DVT/PE after TKR. We used an analysis similar to AHRQ's Patient Safety Indicator number – 12 (PSI 12) which is Postoperative Pulmonary Embolism or Deep Vein Thrombosis but restricted our analysis only to TKR. We intended to capture cases of postoperative venous thromboses and embolism - specifically, pulmonary embolism and deep venous thrombosis. For our analysis we separated TKR into 2 groups; one without DVT/PE and the other with DVT/PE. We analyzed all surgical discharges age 18 years and older with an ICD-9-CM code for an operating room procedure TKR (ICD-9 8154). From this we excluded those who have principal diagnosis of DVT/PE, as these patients are likely to have had PE/DVT present on admission and not because of TKR and also where a procedure for interruption of vena cava (IVC filter) (ICD-9 387) occurs before or on the same day as the first operating room procedure as these patients likely had DVT/PE even before TKR. We then created a subset from the first group, with discharges ICD-9-CM codes for deep vein thrombosis or pulmonary embolism in any secondary diagnosis field and thus defined the group of patients who developed DVT/PE after TKR. We used the following ICD-9 codes to represent DVT (ICD-9 codes 451.11, 451.19, 451.2, 451.81, 451.9, 453.40, 453.41, 453.42, 453.8, 453.9) and PE (ICD-9 codes 415.1–415.19). IBM SPSS Statistics 18 was used for data mining and analysis. Result: In the year 2007, there were 550,770 discharges with a procedure for TKR. After excluding primary diagnosis of DVT/PE and IVC filter, we had 550228 as our working number. Of these, 5454 discharges had a secondary diagnosis of DVT/PE (Rate - 10 new cases per 1000 TKR procedures). Demographics and health care utilization between those who did or did not develop are described in Table 1. Co-morbidities associated with those who did or did not develop DVT are described in (Table 2). Conclusion: DVT & PE are major avoidable complications of Total Knee replacement and are associated with significant mortality and health care costs. These data demonstrate that there may not be any significant differences in age and associated co-morbidities between those who do or do not develop DVT/PE following total knee replacement except for UTI which can be attributed to the difference in length of stay. The absence of serious co-morbidities like AF and CHF in both groups suggest those with serious co-morbidities may not be receiving total knee replacement. That no differences were noticed in associated co-morbidities among those who did or did not develop DVT/PE following TKR provide the rationale for further study of factors contributing to this serious complication of TKR. Such studies may inform future strategies for prevention of post-operative DVT/PE. Disclosure: No relevant conflicts of interest to declare.

scholarly journals (Mis)understanding in patient-health care provider communication about total knee replacement

2008 ◽  
Vol 61 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Richard L. Street ◽  
Marsha N. Richardson ◽  
Vanessa Cox ◽  
Maria E. Suarez-Almazor
Keyword(s):  
Health Care ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Health Care Provider ◽  
Care Provider ◽  
Provider Communication ◽  
Patient Health ◽  
Total Knee ◽  
Health Care Provider Communication
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