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The Bone & Joint Journal
Vol. 102-B, Issue 3 | Pages 310 - 318
1 Mar 2020
Joseph MN Achten J Parsons NR Costa ML

Aims

A pragmatic, single-centre, double-blind randomized clinical trial was conducted in a NHS teaching hospital to evaluate whether there is a difference in functional knee scores, quality-of-life outcome assessments, and complications at one-year after intervention between total knee arthroplasty (TKA) and patellofemoral arthroplasty (PFA) in patients with severe isolated patellofemoral arthritis.

Methods

This parallel, two-arm, superiority trial was powered at 80%, and involved 64 patients with severe isolated patellofemoral arthritis. The primary outcome measure was the functional section of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months. Secondary outcomes were the full 24-item WOMAC, Oxford Knee Score (OKS), American Knee Society Score (AKSS), EuroQol five dimension (EQ-5D) quality-of-life score, the University of California, Los Angeles (UCLA) Physical Activity Rating Scale, and complication rates collected at three, six, and 12 months. For longer-term follow-up, OKS, EQ-5D, and self-reported satisfaction score were collected at 24 and 60 months.


The Bone & Joint Journal
Vol. 95-B, Issue 11 | Pages 1490 - 1496
1 Nov 2013
Ong P Pua Y

Early and accurate prediction of hospital length-of-stay (LOS) in patients undergoing knee replacement is important for economic and operational reasons. Few studies have systematically developed a multivariable model to predict LOS. We performed a retrospective cohort study of 1609 patients aged ≥ 50 years who underwent elective, primary total or unicompartmental knee replacements. Pre-operative candidate predictors included patient demographics, knee function, self-reported measures, surgical factors and discharge plans. In order to develop the model, multivariable regression with bootstrap internal validation was used. The median LOS for the sample was four days (interquartile range 4 to 5). Statistically significant predictors of longer stay included older age, greater number of comorbidities, less knee flexion range of movement, frequent feelings of being down and depressed, greater walking aid support required, total (versus unicompartmental) knee replacement, bilateral surgery, low-volume surgeon, absence of carer at home, and expectation to receive step-down care. For ease of use, these ten variables were used to construct a nomogram-based prediction model which showed adequate predictive accuracy (optimism-corrected R2 = 0.32) and calibration. If externally validated, a prediction model using easily and routinely obtained pre-operative measures may be used to predict absolute LOS in patients following knee replacement and help to better manage these patients.

Cite this article: Bone Joint J 2013;95-B:1490–6.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 11 | Pages 1435 - 1440
1 Nov 2008
Smith IDM Elton R Ballantyne JA Brenkel IJ

In Scotland, the number of primary total knee replacements performed annually has been increasing steadily. The price of the implant is fixed but the length of hospital stay is variable.

We prospectively investigated all patients who underwent primary unilateral total knee replacement in the Scottish region of Fife, between December 1994 and February 2007 and assessed their recorded pre-operative details. The data were analysed using univariate and multiple linear regression statistical analysis.

Data on the length of stay were available from a total of 2106 unilateral total knee replacements. The median length of hospital stay was eight days. The significant pre-operative risk factors for an increased length of stay were the year of admission, details of the consultant looking after the patient, the stair score, the walking-aid score and age.

Awareness of the pre-operative factors which increase the length of hospital stay may provide the opportunity to influence them favourably and to reduce the time in hospital and the associated costs of unilateral total knee replacement.