The failure of survivorship

Wylde, Vikki; Blom, Ashley W

doi:10.1302/0301-620x.93b5.26687

Cited by 56 publications

(43 citation statements)

References 9 publications

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“…Detailed data regarding the patients' medical histories or knee radiographs were not available. Additionally, we do not have any information regarding the preoperative and postoperative functional outcomes which would better reflect the results of the operations than implant survival alone [5,28]. However, to overcome the limitations of single-surgeon or hospital studies, there is a need for register-based studies that reflect Fig.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Niinimäki

Eskelinen

Mäkelä

et al. 2014

Clinical Orthopaedics &Amp; Related Research

154

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Background Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs. Questions/purposes The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period. Methods From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis.

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Section: Discussionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Niinimäki

Eskelinen

Mäkelä

et al. 2014

Clinical Orthopaedics &Amp; Related Research

154

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“…Data collection for groups of underperforming implants or surgical centers is particularly crucial because these implants and the centers at which they are used are at most risk for poorer scores and higher risk of revision. However, revision as the end point might be limited and not always reliable [9,22]. There may be reluctance to offer surgery considering the complexity of the procedure [9] and associated comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…There may be reluctance to offer surgery considering the complexity of the procedure [9] and associated comorbidities. Patients with a poor score who have not been offered revision surgery or elect not to undergo further surgery will not be captured [22]. The PROMS data in this regard might be a better measure of performance and lower scores may indicate a failing implant earlier than the endpoint of revision [9,22].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a poor score who have not been offered revision surgery or elect not to undergo further surgery will not be captured [22]. The PROMS data in this regard might be a better measure of performance and lower scores may indicate a failing implant earlier than the endpoint of revision [9,22]. PROMS data examine changing performance after intervention and the ideal time to review would be when a steady state is achieved.…”

Section: Discussionmentioning

confidence: 99%

“…National registries use revision as an end point to compare the performance of various implants and hospitals. However, survivorship determined by revision fails to capture whether the original operation meets the expectations of the patient and should be supplemented by patient-reported outcome measures (PROMS) [9,22].…”

Section: Introductionmentioning

confidence: 99%

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When Do Patient-reported Assessments Peak after Revision Knee Arthroplasty?

Malviya

Bettinson

Kurtz

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The best timing for patient visits after revision TKA is unclear. Predictors of pain and function reported in the literature typically look at the influence at a given time that might not be ideal if the score is not at a peak or the earliest possible time. Moreover, most reports of predictors include revisions for infection, which typically have a poorer outcome, or for other indications with variable outcome.Questions/purposes We therefore determined (1) the trend of recovery after revision TKA to determine the best time to measure the peak patient-reported pain and function scores and (2) the influence of comorbidities and age on the patterns of recovery. Methods We prospectively followed 120 patients who had revision TKAs from 2003 to 2008. The patients were assessed within 6 weeks before surgery and at 12 weeks, 1 year, and annually thereafter. We obtained WOMAC and SF-36 scores at each visit. We used a linear mixed model analysis to assess predictors. The minimum followup was 2 years (mean, 3 years; range, 2-7 years). Results The majority of improvements in the WOMAC and SF-36 scores occurred during the first year after surgery after which the scores stabilized. One of the seven independent preoperative variables studied (comorbidities) predicted a trend toward improvement of WOMAC pain, WOMAC function, and SF-36 bodily pain scores. The greater the numbers of comorbidities, the worse were the scores. Age, gender, BMI, indication for surgery, and surgeon did not independently influence the WOMAC or SF-36. Conclusion Our data suggest that one of the times for patient visits after revision TKA should be 1 year after surgery. This time allows for key discrimination of implant performance.

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Assessment of chronic post‐surgical pain after knee replacement: Development of a core outcome set

Wylde

MacKichan

Bruce

et al. 2014

European Journal of Pain

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BackgroundApproximately 20% of patients experience chronic post-surgical pain (CPSP) after total knee replacement (TKR). There is scope to improve assessment of CPSP after TKR, and this study aimed to develop a core outcome set.MethodsEighty patients and 43 clinicians were recruited into a three-round modified Delphi study. In Round 1, participants were presented with 56 pain features identified from a systematic review, structured interviews with patients and focus groups with clinicians. Participants assigned importance ratings, using a 1–9 scale, to individual pain features; those features rated as most important were retained in subsequent rounds. Consensus that a pain feature should be included in the core outcome set was defined as the feature having a rating of 7–9 by ≥70% of both panels (patients and clinicians) and 1–3 by ≤15% of both panels or rated as 7–9 by ≥90% of one panel.ResultsRound 1 was completed by 71 patients and 39 clinicians, and Round 3 by 62 patients and 33 clinicians. The final consensus was that 33 pain features were important. These were grouped into an 8-item core outcome set comprising: pain intensity, pain interference with daily living, pain and physical functioning, temporal aspects of pain, pain description, emotional aspects of pain, use of pain medication, and improvement and satisfaction with pain relief.ConclusionsThis core outcome set serves to guide assessment of CPSP after TKR. Consistency in assessment can promote standardized reporting and facilitate comparability between studies that address a common but understudied type of CPSP.

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The failure of survivorship

Abstract: This editorial considers the shortcomings of assessing outcome after joint replacement only by the survival of the implant.

Cited by 56 publications

References 9 publications

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

When Do Patient-reported Assessments Peak after Revision Knee Arthroplasty?

Assessment of chronic post‐surgical pain after knee replacement: Development of a core outcome set

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