To determine the trajectories of patient reported pain and functional disability over five years following total hip arthroplasty (THA) or total knee arthroplasty (TKA). A prospective, longitudinal cohort sub-study within the National Joint Registry (NJR) was undertaken. In all, 20,089 patients who underwent primary THA and 22,489 who underwent primary TKA between 2009 and 2010 were sent Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires at six months, and one, three, and five years postoperatively. OHS and OKS were disaggregated into pain and function subscales. A k-means clustering procedure assigned each patient to a longitudinal trajectory group for pain and function. Ordinal regression was used to predict trajectory group membership using baseline OHS and OKS score, age, BMI, index of multiple deprivation, sex, ethnicity, geographical location, and American Society of Anesthesiologists grade.Aims
Methods
The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state “worse than death” (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group.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
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 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 life expectancy to derive the quality-adjusted life years
(QALYs) gained. 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 after THR than
after TKR (6.5 Cite this article:
