The aim of this study was to perform a cost–utility
analysis of total hip (THR) and knee replacement (TKR). 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 of the modern era, has recently come under
scrutiny. The National Health Service (NHS) has competing demands,
and resource allocation is challenging in times of economic restraint. Patients
who underwent THR (n = 348) or TKR (n = 323) between January and
July 2010 in one Scottish region were entered into a prospective
arthroplasty database. A health–utility score was derived from the
EuroQol (EQ-5D) score pre-operatively and at one year, and was combined
with individual
Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality).Aims
Methods
The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state ‘worse than death’ (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes. A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (Aims
Patients and Methods
The aim of this study was to assess the effect of multimorbidity
on improvements in health-related quality of life (HRQoL) following
total hip arthroplasty (THA) and total knee arthroplasty (TKA). Using data from a regional joint registry for 14 573 patients,
HRQoL was measured prior and one year following surgery using the
Oxford Hip Score (OHS) and Oxford Knee Score (OKS), and the 12-Item
Short-Form Health Survey Physical and Mental Component Summary scores
(PCS and MCS, respectively). Multimorbidity was defined as the concurrence
of two or more self-reported chronic conditions. A linear mixed-effects
model was used to test the effects of multimorbidity and the number
of chronic conditions on improvements in HRQoL.Aims
Patients and Methods
Total knee arthroplasty (TKA) and total hip arthroplasty
(THA) are recognised and proven interventions for patients with
advanced arthritis. Studies to date have demonstrated a steady increase
in the requirement for primary and revision procedures. Projected
estimates made for the United States show that by 2030 the demand
for primary TKA will grow by 673% and for revision TKA by 601% from
the level in 2005. For THA the projected estimates are 174% and
137% for primary and revision surgery, respectively. The purpose
of this study was to see if those predictions were similar for England
and Wales using data from the National Joint Registry and the Office
of National Statistics. Analysis of data for England and Wales suggest that by 2030,
the volume of primary and revision TKAs will have increased by 117%
and 332%, respectively between 2012 and 2030. The data for the United
States translates to a 306% cumulative rate of increase between
2012 and 2030 for revision surgery, which is similar to our predictions
for England and Wales. The predictions from the United States for primary TKA were similar
to our upper limit projections. For THA, we predicted an increase
of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic
burden of arthroplasty in the future in England and Wales as a real
and unaddressed problem. This will have significant implications
for the provision of health care and the management of orthopaedic
services in the future. Cite this article:
The Unified Classification System (UCS) was introduced
because of a growing need to have a standardised universal classification
system of periprosthetic fractures. It combines and simplifies many
existing classification systems, and can be applied to any fracture
around any partial or total joint replacement occurring during or
after operation. Our goal was to assess the inter- and intra-observer
reliability of the UCS in association with knee replacement when
classifying fractures affecting one or more of the femur, tibia
or patella. We used an international panel of ten orthopaedic surgeons with
subspecialty fellowship training and expertise in adult hip and
knee reconstruction (‘experts’) and ten residents of orthopaedic
surgery in the last two years of training (‘pre-experts’). They
each received 15 radiographs for evaluation. After six weeks they
evaluated the same radiographs again but in a different order. The reliability was assessed using the Kappa and weighted Kappa
values. The Kappa values for inter-observer reliability for the experts
and the pre-experts were 0.741 (95% confidence interval (CI) 0.707
to 0.774) and 0.765 (95% CI 0.733 to 0.797), respectively. The weighted
Kappa values for intra-observer reliability for the experts and
pre-experts were 0.898 (95% CI 0.846 to 0.950) and 0.878 (95% CI
0.815 to 0.942) respectively. The UCS has substantial inter-observer reliability and ‘near
perfect’ intra-observer reliability when used for periprosthetic
fractures in association with knee replacement in the hands of experienced
and inexperienced users. Cite this article:
We compared the length of hospitalisation, rate
of infection, dislocation of the hip and revision, and mortality following
primary hip and knee arthroplasty for osteoarthritis in patients
with Alzheimer’s disease (n = 1064) and a matched control group
(n = 3192). The data were collected from nationwide Finnish health
registers. Patients with Alzheimer’s disease had a longer peri-operative
hospitalisation (median 13 days Cite this article:
Using the General Practice Research Database, we examined the temporal changes in the rates of primary total hip (THR) and total knee (TKR) replacement, the age at operation and the female-to-male ratio between 1991 and 2006 in the United Kingdom. We identified 27 113 patients with THR and 23 843 with TKR. The rate of performance of THR and TKR had increased significantly (p <
0.0001 for both) during the 16-year period and was greater for TKR, especially in the last five years. The mean age at operation was greater for women than for men and had remained stable throughout the period of study. The female-to-male ratio was higher for THR and TKR and had remained stable. The data support the notion that the rate of joint replacement is increasing in the United Kingdom with the rate of TKR rising at the highest rate. The perception that the mean age for TKR has decreased over time is not supported.
