337 Patterns of Population Use of Total Joint Arthroplasty: Focus on Outcomes Following a Single Primary Tja Is Too Narrow

Croxford, Ruth; Hawker, G.A.

doi:10.1016/s1063-4584(11)60364-6

Cited by 2 publications

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“…Consistent with this hypothesis, a good outcome was achieved in a higher proportion of patients when outcome was defined solely based on improvements in pain versus function, and a good outcome was achieved in fewer patients when a good outcome was defined as an improvement in function. At a population level, one-quarter of recipients of elective TJA undergo a second elective TJA within 1-2 years of the index procedure (49). For patients with more than one symptomatic hip or knee, multiple TJA procedures, e.g., planned sequential and/or bilateral procedures, may be required in order to achieve maximal improvement in both pain and functioning.…”

Section: Discussionmentioning

confidence: 99%

Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?

Hawker

Badley

Borkhoff

et al. 2013

Arthritis & Rheumatism

170

165

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Objective. To evaluate patient predictors of good outcome following total joint arthroplasty (TJA).Methods. A population cohort with hip/knee arthritis (osteoarthritis [OA] or inflammatory arthritis) ages >55 years was recruited between 1996 and 1998 (baseline) and assessed annually for demographics, troublesome joints, health status, and overall hip/knee arthritis severity using the Western Ontario and McMaster Universities OA Index (WOMAC). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as an improvement in WOMAC summary score greater than or equal to the minimal important difference (MID; 0.5 SD of the mean change). Logistic regression and Akaike's information criterion were used to determine the optimal number of predictors and the best model of that size. Log Poisson regression was used to determine the relative risk (RR) for a good outcome.Results. Primary TJA was performed in 202 patients (mean age 71.0 years; 79.7% female; 82.7% with >1 troublesome hip/knee; 65.8% knee replacements). Mean improvement in WOMAC summary score was 10.2 points (SD 18.05; MID 9 points). Of these patients, 53.5% experienced a good outcome. Four predictors were optimal. The best 4-variable model included pre-TJA WOMAC, comorbidity, number of troublesome hips/knees, and arthritis type (C statistic 0.80). The probability of a good outcome was greater with worse (higher) pre-TJA WOMAC summary scores (adjusted RR 1.32 per 10-point increase; P < 0.0001), fewer troublesome hips/knees (adjusted RR 0.82 per joint; P ‫؍‬ 0.002), OA (adjusted RR for rheumatoid arthritis versus OA 0.33; P ‫؍‬ 0.009), and fewer comorbidities (adjusted RR per condition 0.88; P ‫؍‬ 0.01).Conclusion. In an OA cohort with a high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted.

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Section: Discussionmentioning

confidence: 99%

Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?

Hawker

Badley

Borkhoff

et al. 2013

Arthritis & Rheumatism

170

165

View full text Add to dashboard Cite

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“…Mulit‐joint OA that initially presents as monoarticular symptomatic OA is an increasingly recognized issue . A more comprehensive approach to the joint replacement patient that takes into account the status of the other large joints may be advisable .…”

Section: Discussionmentioning

confidence: 99%

“…End stage osteoarthritis (OA) is typically approached as a monoarticular disease unless a patient has multiple symptomatic joints at the time of presentation to an orthopedic surgeon. However, at having OA in one large joint is itself a risk factor for having OA in several joints, and many patients ultimately have several joints replaced over a lifetime . The factors related to the progression of OA from joint to joint are not well understood, but because it appears to follow a predictable sequence, some suggest that joint biomechanics are involved …”

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confidence: 99%

“…Studying gait biomechanics in unilateral total hip replacement (THR) patients provides insight into the mechanisms of joint‐to‐joint OA development. Up to 30% of patients who receive a unilateral THR ultimately require a second primary hip or knee replacement . Although the most common joint to be replaced after a unilateral THR is the contralateral hip, in cases where a knee replacement is later required, the contralateral knee is more likely to be involved than the ipsilateral knee .…”

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confidence: 99%

“…Up to 30% of patients who receive a unilateral THR ultimately require a second primary hip or knee replacement . Although the most common joint to be replaced after a unilateral THR is the contralateral hip, in cases where a knee replacement is later required, the contralateral knee is more likely to be involved than the ipsilateral knee . Abnormal patterns of joint loading contribute to the development and progression of medial compartment knee OA, but how the biomechanical changes that occur at the operated hip affect knee loading is unknown.…”

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confidence: 99%

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Does hip implant positioning affect the peak external adduction moments of the healthy knees of subjects with total hip replacements?

Foucher

Wimmer

2013

J. Orthop. Res.

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After unilateral total hip replacement (THR) for hip osteoarthritis (OA), knee OA incidence or progression is common. The contralateral knee is at particular risk, and some have speculated that abnormal THR-hip biomechanics contributes to this asymmetry. We investigated the relationships between operated-hip joint geometry or gait variables and the peak external knee adduction momentsan indicator of knee OA risk-in 21 subjects with unilateral THRs. We found that the peak adduction moment was 14% higher on the contralateral versus the ipsilateral knee (p ¼ 0.131). The best predictors of ipsilateral knee adduction moments were superior-inferior joint center position and operated-hip peak adduction moment (adj R 2 ¼ 0.291, p ¼ 0.017). The sole predictor of the contralateral knee adduction moment was the medial-lateral hip center position (adj R 2 ¼ 0.266, p ¼ 0.010). A postoperative medial shift of the hip center was significantly correlated with a lower postoperative contralateral/ipsilateral knee adduction moment ratio (R ¼ 0.462, p ¼ 0.035). Based on these relationships, we concluded that implant positioning could influence the biomechanical risk of knee OA progression after THR. Although implant positioning decisions are necessarily driven by other factors, it may be appropriate to assess individual THR candidate's knee OA risk and adjust perioperative management accordingly. ß

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337 Patterns of Population Use of Total Joint Arthroplasty: Focus on Outcomes Following a Single Primary Tja Is Too Narrow

Cited by 2 publications

References 0 publications

Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?

Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?

Does hip implant positioning affect the peak external adduction moments of the healthy knees of subjects with total hip replacements?

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