Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review

Klem, Nardia-Rose; Smith, Anne; Dowsey, Michelle M.; Fary, Robyn; Schütze, Robert; O’Sullivan, Peter; Choong, Peter; Bunzli, Samantha

doi:10.1016/j.ocarto.2020.100032

Cited by 26 publications

(31 citation statements)

References 70 publications

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“…The trajectory of progress from technique and implant design alone is reaching a plateau [ 15 , 16 ]. Furthermore, patients are dissatisfied despite what surgeons would perceive as successful surgery [ 17 ]. An alternative solution to TKA would be a completely new treatment for knee OA; a solution that addresses both the symptoms and natural history of the disease.…”

Section: Introductionmentioning

confidence: 99%

Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial

Zhou

Weeden

Patten

et al. 2022

BMC Musculoskelet Disord

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Background Approximately 1 in 5 patients feel unsatisfied after total knee arthroplasty (TKA). Prognostic tools may aid in the patient selection process and reduce the proportion of patients who experience unsatisfactory surgery. This study uses the prognostic tool SMART Choice (Patient Prognostic Tool for Total Knee Arthroplasty) to predict patient improvement after TKA. The tool aims to be used by the patient without clinician input and does not require clinical data such as X-ray findings or blood results. The objective of this study is to evaluate the SMART Choice tool on patient decision making, particularly willingness for surgery. We hypothesise that the use of the SMART Choice tool will influence willingness to undergo surgery, especially when used earlier in the patient TKA journey. Methods This is a multicentred, pragmatic, randomised controlled trial conducted in Melbourne, Australia. Participants will be recruited from the St. Vincent’s Hospital, Melbourne (SVHM) Orthopaedic Clinic, and the client base of HCF, Australia (private health insurance company). Patients over 45 years of age who have been diagnosed with knee osteoarthritis and considering TKA are eligible for participation. Participants will be randomised to either use the SMART Choice tool or treatment as usual. The SMART Choice tool provides users with a prediction for improvement or deterioration / no change after surgery based on utility score change calculated from the Veterans-RAND 12 (VR-12) survey. The primary outcome of the study is patient willingness for TKA surgery. The secondary outcomes include evaluating the optimal timing for tool use and using decision quality questionnaires to understand the patient experience when using the tool. Participants will be followed up for 6 months from the time of recruitment. Discussion The SMART Choice tool has the potential to improve patient decision making for TKA. Although many prognostic tools have been developed for other areas of surgery, most are confined within academic bodies of work. This study will be one of the first to evaluate the impact of a prognostic tool on patient decision making using a prospective clinical trial, an important step in transitioning the tool for use in clinical practice. Trial registration Australia and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12622000072718. Prospectively registered – 21 January 2022.

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Section: Introductionmentioning

confidence: 99%

Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial

Zhou

Weeden

Patten

et al. 2022

BMC Musculoskelet Disord

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“…Total joint arthroplasty is considered as the definitive treatment for pain and disability ensuing primarily from end-stage osteoarthritis of the hip and the knee ( 1 ). Both total hip arthroplasty (THA) and total knee arthroplasty (TKA) are long-demonstrated to confer significant improvements in patient metrics for pain and function ( 2 , 3 , 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee

et al. 2022

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Use of articular antibiotic-eluting cement spacers during two-stage revision arthroplasty for prosthetic joint infection (PJI) is a long-established and proven adjunctive technique during first-stage surgery. Articular spacers come in many forms, either static or dynamic. The authors present an instructional review of current evidence regarding their use. A total of 45 studies (for spacer use in PJI involving either hip or knee) were analysed for data regarding eradication rate, functional outcomes, mechanical complications and the impact on second-stage surgery. A large number of case series and retrospective cohort studies were retrieved, with only a small number of prospective studies (2). High levels of infection eradication were commonly reported (>80%). Outcome scores were commonly reported as indicating good-to-excellent function and pain levels. Second-stage procedures were often not required when dynamic spacers were used. Static spacers were associated with more mechanical complications in both the hip and the knee. In the hip, dynamic spacers were more commonly associated with instability compared to static spacers. Consideration should be given to the use of dual-mobility or constrained definitive acetabular components in these cases at second-stage surgery. The use of antibiotic-eluting polymethylmethacrylate articular spacers in two-stage revision for PJI of hip and knee arthroplasty achieves a high rate of infection eradication. Dynamic spacers may confer a variety of benefits compared to static spacers, with a similar rate of infection eradication.

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“…At present, oral analgesic medication and other drug therapies are the key methods to treat patients with mild KOA, but drug therapies cannot fully meet the needs of knee joint rehabilitation of patients with severe KOA, so surgery is an important measure to protect the knee function of patients with severe KOA. e most common surgical treatments include total knee arthroplasty (TKA) and arthroscopic debridement [4][5][6][7]. TKA is a comprehensive expression of medical science and can be used for treating various terminal stage diseases of knee joints.…”

Section: Introductionmentioning

confidence: 99%

Safety of Total Knee Arthroplasty in the Treatment of Knee Osteoarthritis and Its Effect on Postoperative Pain and Quality of Life of Patients

Zhang

Liu

2021

Contrast Media & Molecular Imaging

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Objective. To explore the safety of total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA) and its impact on patients’ postoperative pain and quality of life. Methods. A total of 60 KOA patients admitted to our hospital from January 2019 to January 2020 were selected as the research objects. The knee joint scores (HSS) before and after TKA were compared, and the patients’ quality of life was evaluated using the Osteoarthritis Index of Western Ontario and McMaster University (WOMAC). At the same time, the number of patients with complications was recorded, and the efficacy of TKA was comprehensively analyzed. Results. The postoperative HSS score was significantly higher than the preoperative score ( P < 0.05 ), the postoperative pain score increased with time, and the pain gradually decreased. The postoperative WOMAC score was significantly lower than the preoperative score ( P < 0.001 ), and the score at 6 months after surgery was significantly lower than that at 3 months after surgery ( P < 0.001 ). There were no complications such as severe prosthesis fracture, secondary sepsis, and patellar tendon rupture, and the total incidence of complications was 11.7%. The effective rate of treatment at 6 months after operation was 98.3%, which was significantly higher than that at 3 months after operation ( P < 0.05 ). Conclusion. Total knee arthroplasty can improve the knee joint function of patients with knee osteoarthritis, with low postoperative pain, low complication rate, and good quality of life for patients. It is worthy of promotion and application.

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Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review

Cited by 26 publications

References 70 publications

Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial

Evaluating willingness for surgery using the SMART Choice (Knee) patient prognostic tool for total knee arthroplasty: study protocol for a pragmatic randomised controlled trial

Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee

Safety of Total Knee Arthroplasty in the Treatment of Knee Osteoarthritis and Its Effect on Postoperative Pain and Quality of Life of Patients

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