The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement
ABSTRACT Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures. Using National Joint Registry (NJR) data linked to PROMs we identified 22,691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis. After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient's general health status. Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR. In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.
The Knee 09/2013; 20:S16-S20. DOI:10.1016/S0968-0160(13)70004-8 · 1.70 Impact Factor
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ABSTRACT: Background The trochlea is often medialized after total knee arthroplasty (TKA) resulting in abnormal patellar tracking, which may lead to anterior knee pain. However, due to the difference in shape of the natural trochlea and the patellar groove of the femoral component, a medialization of the femoral component of 5 mm results in an equal patellar position at 0–30° of flexion. We tested the hypothesis that more medialization of the trochlea results in a higher VAS pain score and lower Kujala anterior knee pain score at midterm follow-up. Methods During surgery a special instrument was used to measure the mediolateral position of the natural trochlea and the prosthetic groove in 61 patients between 2004 and 2005. Patient reported outcome measures were used to investigate the clinical results (NRS-pain, NRS-satisfaction, KOOS-PS and Kujala knee score). Results In total 40 patients were included. The mean follow-up was 8.8 years. A medialization of ≥ 5 mm resulted in a significantly lower NRS-pain (0.2 vs. 1.4; p = 0.004) and higher NRS-satisfaction (9.6 vs. 8.2; p = 0.045). Overall clinical results were good; KOOS-PS was 33.9 and Kujala knee score was 72.1. Conclusions The present study showed that a more medial position may result in a better postoperative outcome, which can probably be explained by the non-physiological lateral orientation of the trochlear groove in TKA designs. Level of evidence: Level IIIThe Knee 09/2014; 21(6). DOI:10.1016/j.knee.2014.08.007 · 1.70 Impact Factor
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ABSTRACT: The Journey bicruciate substituting (BCS) total knee replacement (TKR) is intended to improve knee kinematics by more closely approximating the surfaces of a normal knee. The purpose of this analysis was to address the safety of Journey BCS knees by studying early complication and revision rates in a consecutive case series. Between December 2006 and May 2011, a single surgeon implanted 226 Journey BCS total knee prostheses in 191 patients (124 women, 67 men) who were eligible for study. Mean age at surgery was 68 years (41-85 years).Outcome measures were early complications and minor and major revision rates. All complications were considered, irrespective of whether conservative treatment or revision was required. The average implantation time was 3.5 years (range 1.3-5.8 years). Thirty-three complications (14.6% of 226 knees) required minor or major revision surgery in 25 patients. The remaining eight patients were treated conservatively. Sixteen minor revisions were performed in 12 patients. Thirteen major revisions were required in 13 patients, which results in a rate of 1.65 major revisions per 100 component years. The linear trend of the early complication rate by treatment year was not significant (p = .22).Multivariate logistic regression showed no significant predictors for the occurrence of a complication or for revision surgery. A tendency towards higher complication rates was observed in female patients, although it was not significant (p = .066). The complication and revision rates of the Journey BCS knee implant are high in comparison with those reported for other established total knee systems. Caution is advised when using this implant, particularly for less experienced knee surgeons.BMC Musculoskeletal Disorders 11/2014; 15(1):395. DOI:10.1186/1471-2474-15-395 · 1.90 Impact Factor