Total Hip Arthroplasty Improves the Quality-Adjusted Life Years in Patients Who Exceeded the Estimated Life Expectancy

Dimitriou, Dimitrios; Antoniadis, Alexander; Flury, Andreas; Liebhauser, Martin; Helmy, Naeder

doi:10.1016/j.arth.2018.07.005

Cited by 28 publications

(33 citation statements)

References 22 publications

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“…Recently, more than 370 thousand THA and 700 thousand TKA were operated in the USA with an increasing trend in the foreseeable future [2,3]. However, about half of patients undergoing TKA and THA suffer from severe postoperative pain in spite of multimodal analgesia [4,5]. Pain after total joint arthroplasty is the most common cause of prolonging length of hospital stay and functional recovery as well as a common reason for readmission [6].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Kang

Zhao

et al. 2020

J Orthop Surg Res

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Background: Postoperative pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) influence patients' rehabilitation and life quality. Although gabapentin has been widely used for analgesia, its efficacy is still controversial in TKA and THA. This meta-analysis was performed to assess the efficacy and safety of gabapentin following TKA and THA. Method: Electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, MEDLINE, and ClinicalTrials.gov were comprehensively retrieved for randomized controlled trials from their inception to June 2019. A total of 7 studies, which compared the administration of gabapentin with that of placebo for the treatment of postoperative pain, were included in our meta-analysis. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result: There was no difference in pain score at 24 (P = 0.87), 48 (P = 0.15), and 72 (P = 0.85) h associated with the use of gabapentin. Likewise, no difference in accumulative morphine consumption at 48 h following TKA or THA was found between gabapentin and placebo (DM = − 8.14, 95% CI − 18.55 to 2.28, P = 0.13). The incidence of opioid-related adverse effects, including nausea, pruritus, sedation, and dizziness, is no difference between gabapentin and placebo group. However, subgroup analysis indicated that gabapentin could reduce the incidence of pruritus after TKA (RR = 0.35, 95% CI 0.12 to 0.99, P = 0.05). Conclusion: Based on our meta-analysis, gabapentin did not decrease postoperative pain, cumulative morphine consumption, and the incidence of adverse effects after TKA and THA. There was not enough evidence to support the administrations of gabapentin for postoperative pain after TKA and THA.

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Section: Introductionmentioning

confidence: 99%

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Kang

Zhao

et al. 2020

J Orthop Surg Res

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“…Patient’s pre-operative and post-operative health status was measured with the EuroQol-5D (EQ-5D) score [ 24 ]. Each question of the EQ-5D was scored and then converted to EQ-5D utility score [ 14 ]. An EQ-5D utility score of 1 equates to one QALY.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies reported significant improvement in QALY after total hip and knee arthroplasty in global cohorts of patients [ 14 – 17 ]. However, to our knowledge, no study was dedicated to evaluate the improvement in quality of life that could be expected after TKA in patients who exceeded their estimated life expectancy at the time of surgery in order to balance the risk-benefit ratio of this elective procedure in these specific patients [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Palazzuolo

Antoniadis

Mahlouly

et al. 2021

International Orthopaedics (SICOT)

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Purpose Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis though its risk-benefit ratio in elderly patients remains debated. This study aimed to evaluate the functional outcome, rates of complication and mortality, and quality-adjusted life years (QALY) in patients who exceeded their estimated life expectancy. Methods Ninety-seven TKA implanted in 86 patients who exceeded their estimated life expectancy at the time of TKA were prospectively included in our institutional joint registry and retrospectively analyzed. At latest follow-up, the functional outcome with the Knee Society Score (KSS), rates of complication and mortality, and QALY with utility value of EuroQol-5D score were evaluated. Results At a mean follow-up of three ± one years, the pre- to post-operative KSS improved significantly (p < 0.01). The rates of surgical and major medical complications related to TKA were 3% and 10%, respectively. The re-operation rate with readmission was 3% while no TKA was revised. The 30-day and one year mortality was 1% and 3%, respectively. The pre- to one year post-operative QALY improved significantly (p < 0.01). The cumulative QALY five years after TKA was four years. Assuming that these patients did not undergo TKA, their cumulative QALY at five years would have been only two years. Conclusion TKA is an effective procedure for the treatment of end-stage osteoarthritis in patients who exceeded their estimated life expectancy. TKA provided significant improvement in function and quality of life without adversely affecting overall morbidity and mortality. Therefore, TKA should not be contra-indicated in elderly patients based on their advanced age alone.

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“…Total hip arthroplasty (THA) provides reliable outcomes for patients suffering from end-stage degenerative hip osteoarthritis (OA), especially pain relief, functional restoration, and overall improved quality of life. [1][2][3] Its high rate of cost effectiveness has allowed to be widely distributed in all mid-to advanced healthcare systems to such an extent that more than 1 million THA are performed worldwide yearly. [4][5][6] 1 of the causes that most provoke its failure is the insurgence of periprosthetic joint infection (PJI), which has an incidence, following primary THA, of 1-2% approximately and is the leading cause of revision of THA in many published registers and large cohort studies.…”

Section: Introductionmentioning

confidence: 99%

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

et al. 2020

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In this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12-week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI.

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Total Hip Arthroplasty Improves the Quality-Adjusted Life Years in Patients Who Exceeded the Estimated Life Expectancy

Cited by 28 publications

References 22 publications

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

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