This study assessed whether patient satisfaction with their hospital stay influences the early outcome of total knee replacement (TKR).

During a five year period patients undergoing primary TKR at the study centre had prospectively outcome data recorded (n=2264). Patients with depression (p=0.04) and worse mental wellbeing (p<0.001), according to the short form (SF)-12, were more likely to be dissatisfied with their hospital stay. Decreasing level of satisfaction with their hospital stay was associated with a significantly worse post-operative OKS (p<0.001) and SF-12 score (p<0.001). Multivariable regression analysis confirmed that the patients perceived level of satisfaction with their hospital stay was an independent predictor of change in the OKS (p<0.001) and SF-12 score (p<0.001) after adjusting for confounding variables. Patient satisfaction with their TKR was significantly influenced by their hospital experience, decreasing from 96% in those with an excellent experience to 42% in those with a poor experience. Food, staff/care, and the hospital environment were the most frequent reasons of why patients rated their hospital experience as fair or poor.

A patient's perception of their inpatient hospital experience after surgery is an important modifiable predictor of early functional outcome and satisfaction with TKR.

Many psychological factors have been associated with function after joint replacement. Personality is a stable pattern of responses to external conditions and stimuli. The aim of this study was to investigate the relationship between personality, joint function, and general physical in patients undergoing total hip (THR) and knee replacement (TKR).

We undertook a prospective cohort study of 184 patients undergoing THA and 205 undergoing TKA. Personality was assesed using the Eysneck Personality Questionaire, brief version (EPQ-BV). Physical health was measured using the EuroQol (EQ-5D). Joint function was measured using the relevant Oxford Score. Outcomes were assessed at six months. Multivariable models were constructed.

The stable introvert personality was most common. Unstable introverts had poorer pre-operative function with hip arthrosis, but not knee arthrosis. Personality was not directly associated with post-operative function – the only independent predictors were pre-operative function (p=0.002) and comorbidity (p<0.001). While satisfaction after TKR was associated with personality (p=0.026), there was no association after THR (p=0.453). The poorest satisfaction was in those with the unstable introvert personality type.

Personality was a predictor of preoperative status. It did not have a direct association with postoperative status, but may have as preoperative function was the main predictor of postoperative function, personality may have had an indirect effect. Personality was also a predictor of satisfaction after TKR. This suggests that predicting satisfaction after knee replacement is more complex. Therefore certain patient may benefit from a tailored preoperative education to explore and manage expectations.

Expectations of patients requiring knee arthroplasty surgery have become higher than in the past, with more strain being put on modern prostheses by fitter and younger patients. The objective of this study was to analyse the survivorship of primary knee arthroplasties at a minimum of ten years, with end points of revision and death. Patients who had a total (TKA) or unicompartmental (UKA) knee arthroplasty performed at a university teaching hospital were identified from the local arthroplasty database. Electronic and operative records were analysed to determine parameters including operative indication, subsequent revision surgery, and patient mortality. Results were collated and analysed using PASW software.

A total of 1023 patients were recruited, with 566 (55%) female and 457 (45%) male. Minimum follow up was 10.1 years, with an average of 12.1 years (S.D 0.87). 64.9% of patients were alive at follow up, with an average age of 79.7 years (S.D 8.7). 92.8% were operated on for osteoarthritis (OA), 6.6% for rheumatoid arthritis (RA) and 0.6% for other indications. Kaplan–Meier analysis estimated survival of 94% (S.D 0.008) at eleven years, with no statistical difference found in survivorship of knees operated on for OA or RA. Similarly no statistical difference was found between survivorship of UKA or TKA implants. Of those that died by follow up, 95.2% did so with their original implant.

We conclude that both TKA and UKA offer a lasting solution for patients, with excellent outcomes achieved in both rheumatoid and osteoarthritic patients.

Nerve damage is a complication of THA and TKA procedures. The incidence of subclinical nerve injury following arthroplasty is unknown. The aim was to determine the prevalence of asymptomatic nerve deficits in an arthroplasty population group, and the incidence of post-operative changes in nerve function. A Secondary aim was to identify the nature of any deficits. And the association between nerve deficits and history of backache.

A non-randomised prospective series of patients undergoing lower limb arthroplasty for osteoarthritis were studied at a single hospital. The peroneal nerve was investigated using nerve conduction in forty patients. Twenty patients had upper limb testing to differentiate between a polyneuropathy or isolated lower limb neuropathy.

Nerve function deficits were detected in the peroneal nerve in fifteen patients pre-operatively and fifteen post-operatively, of those twelve had A waves detected suggestive of a generalised neuropathy. Ten patients who had upper limb testing had a conduction defect (five had asymptomatic Carpal tunnel). There was a positive correlation between presence of post-operative deficit and age(r=0.389, p=0.013). A negative correlation was found for presence of post-operative A waves and BMI(r=−0.370, p=0.019).

The prevalence of pre-operative subclinical peroneal neuropathy is much higher than expected in this group (37.5%) of arthroplasty patients. There is a strong correlation between presence of post-operative conduction abnormalities and age. There is no relationship between peripheral neuropathy and history of backache or residual post-operative deficit.

The aim was to perform a cost-utility analysis of total joint replacement in the current environment.

Arthritis is a disabling condition that leads to long-term deterioration in quality of life. Total joint replacement, despite being one of the greatest advances in medicine in the modern era, has come under recent scrutiny. The National Health Service (NHS) has competing demands and resource allocation is challenging in times of economic restraint.

Patients undergoing total hip (n=348) and knee arthroplasty (n=323), from January to July 2010, were entered into a prospective arthroplasty database. A health utility score was derived from the Euroqol (EQ-5D) score preoperatively, and at one year, and was combined with individual life expectancy to derive the Quality-Adujusted-Life-Years (QALYs) gained. Predicted need for revision surgery was Incorporated in the model. The 2011–12 Scottish Tariff was used. Two-way analysis of variance was used to compare QALYs gained between procedures, while controlling for baseline differences.

The number of QALYs gained was higher in THR versus TKR (6.53 vs 4.04 years, p<0.001). The cost per QALY for THR was £1371 (95% CI £1194 to £1614) compared with £2101 (£1762 to £2620) for TKR. Predictors of an increase in QALYs gained were poorer health prior to surgery (p<0.001) and younger age (p<0.001). General health (EQ-5D VAS) showed greater improvement in THR versus TKR (p<0.001).

This study provides up to date cost-effectiveness data for total joint replacement. THR and TKR are both extremely clinically and cost-effective interventions, with costs that compare favourably with other medical interventions (e.g. laparoscopic hernia repair vs open: £55,548 per QALY; CHD primary prevention with statins: £21,000).

There is limited literature regarding the outcome of hip and knee arthroplasty (THR and TKR) in the Super-Elderly (≥80yrs). The aim is to compare the outcome of THR and TKR in the Super-Elderly with a standard-age cohort of patients. From January 2006 to August 2008; 1290 TKR and 1344 THR were performed at the study institute. Comorbidity, length of stay, patient satisfaction, Oxford knee or hip scores, and SF12 scores were recorded prospectively. The Oxford Score and SF12 were recorded at one year. The mode age range was 65-74yrs for TKR (n=492) and THR (n=495), deemed the standard cohort. 185 TKR and 171 THR were performed in the Super-Elderly. Outcome in this cohort was compared to the standard.

The standard cohort had a greater absolute improvement in Oxford knee scores (15.8 and 14.7.p=0.2). Improvement of absolute Oxford hip scores revealed no difference (20.0 and 20.2.p=0.8), but the Super-Elderly had a greater improvement in pain components (11.0 vs.12.0.p=0.05) with a lesser improvement of the functional components (9.0.vs.8.2.p=0.05). There was a greater improvement in the physical component of the SF-12 score in the standard cohort for both TKR and THR (10.6.vs.7.9.p=0.05 and 14.4.vs.10.4.p=<0.01, respectively).

No significant difference was seen in comorbidities, but the Super-Elderly patients had a longer hospital stay for TKR (6.2.vs.8.3.p=0.01) and THR (5.9.vs.9.0.p=0.01).

The Super-Elderly were more satisfied with their surgery (p=0.05).

Super-Elderly patients have comparable outcomes to their younger counterparts and are more satisfied with their surgery, but they may require a longer length of stay.