Measuring Tools for Functional Outcomes in Total Knee Arthroplasty

London Health Sciences Centre, University of Western Ontario, University Campus, London, ON, Canada.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 10/2008; 466(11):2634-8. DOI: 10.1007/s11999-008-0468-0
Source: PubMed


Total knee arthroplasty has come under increasing scrutiny attributable to the fact that it is a high-volume, high-cost medical intervention in an era of increasingly scarce medical resources. Health-related quality-of-life outcomes have been developed such that healthcare providers might determine how good an intervention is and whether it is cost-effective. Total knee arthroplasty has been subjected to disease-specific, patient-specific, global health, functional capacity, and cost-to-utility outcome measures. Patient satisfaction is high (90%) after total knee arthroplasty and 93% of patients would have this operative procedure again. Large improvements in preoperative to postoperative WOMAC scores occurred (over 39 of 100 points in 82% of patients). Cost-to-quality outcomes demonstrated total knee arthroplasties are extremely cost-effective. This analysis documents total knee arthroplasty is a highly efficacious procedure that competes favorably with all medical and surgical interventions.

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    • "Despite the importance of stair climbing and the high activity limitation prevalence in this population, there was not enough data in the literature exploring the long term effects of knee replacement surgery on stair climbing. Previous studies focused the ability of individuals to ascend and descend stairs after knee replacement only with one or two questions without detailed evaluation such as climbing pattern, handrail or assistive device use [7] [9] [26] [27]. Another study focused particularly on speed and time to complete a stair-climbing task regardless of the use of a handrail or assistance. "
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    ABSTRACT: (1) to evaluate the change in time of pain, stair climbing ability and fear of falling (FOF), (2) to determine the association between pain, stair climbing ability and FOF for patients with knee osteoarthritis (OA) following the knee replacement over the course of six months, (3) and to compare the results with healthy controls in terms of stair climbing ability and FOF. Fifteen female healthy controls and 21 female consecutive subjects who were scheduled to undergo primary bilateral knee replacement for the treatment of knee OA were involved. Pain, stair climbing ability and FOF were assessed with a numerical pain rating scale, Going up and Down Scale (GUDS) and Tampa Scale for Kinesiophobia (TSK) at pre-surgery and discharge. After discharge, patients were asked to answer the outcome measures at 2, 4, 8, 12 and 26 week by phone. Patients had significantly improvement in the postoperative 26-week scores of pain (p< 0.001), stair ability (p< 0.001), and FOF (p=0.006) compared with the preoperative scores. There was also decreased pain at 4.week, improved stair ability at 8.week, and delayed improvement at FOF in patients. While patients had significantly worse stair ability than controls preoperatively (p< 0.001), the difference was not significant at postoperative 26-week (p=0.561). A positive significant correlation was found between the stair ability, FOF and pain scores (p< 0.001).CONCLUSION: It would be reasonable to consider that FOF control is potentially useful for preventing severe functional limitation in stair climbing for subsequent knee OA before and early after the surgery.
    Journal of Back and Musculoskeletal Rehabilitation 06/2013; 27(1). DOI:10.3233/BMR-130422 · 0.71 Impact Factor
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    • "The Self-Administered Patient Satisfaction Scale (SAPS) was designed to be used in conjunction with other clinical measures and functional health status instruments to evaluate the results of hip and knee arthroplasty. We hypothesized that individuals who experienced less pain and better functioning and greater improvements in these areas would likewise show greater satisfaction with their surgery [8] [13] "
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    ABSTRACT: Introduction. The objective of this study was to develop a short self-report questionnaire for evaluating patient satisfaction with the outcome of hip and knee replacement surgery. Methods. This scale consists of four items focusing on satisfaction with the extent of pain relief, improvement in ability to perform home or yard work, ability to perform recreational activities, and overall satisfaction with joint replacement. This instrument does not measure satisfaction with process of care. The responses are scored on a Likert scale, with the total score ranging from 25 to 100 per question. The instrument was tested on 1700 patients undergoing primary total hip and total knee replacement surgery, evaluated preoperatively, at 12 weeks, and one year postoperatively. Psychometric testing included internal consistency, measured with Cronbach's alpha, and convergent validity, measured by correlation with changes in measures of health status between the preoperative, 12-week, and one-year evaluations. Results. The internal consistency (reliability) of the scale, measured by the Cronbach's alpha, ranged from 0.86 to 0.92. The scale demonstrated substantial ceiling effects at 1 year. The scale scores correlated modestly with the absolute SF-36 PCS and WOMAC scores (ρ = 0.56-0.63 and also with the WOMAC change scores (ρ = 0.38-0.46) at both 12-week and 1-year followups. Conclusions. This instrument is valid and reliable for measuring patient satisfaction following primary hip and knee arthroplasty and could be further evaluated for use with other musculoskeletal interventions.
    01/2011; 2011(4):591253. DOI:10.1155/2011/591253
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    • "Many articles have so far reported that total joint arthroplasties were extremely effective for treating the destroyed joints in the patients afflicted with such diseases as rheumatoid arthritis, osteoarthritis, or osteonecrosis (Keisu et al., 2001; Ritter et al., 2007). Total joint arthroplasty is the major treatment option for pain and physical disabilities, and it can improve the patient's quality of life (Fujita et al., 2006; Bourne, 2008). However, the surgical stress of total joint arthroplasty may be too great for the patients. "
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    ABSTRACT: This study aims to clarify the difference between surgical stress of total hip arthroplasty (THA) and total knee arthroplasty (TKA) under the same conditions through blood transfusion and ischemic extremity. Body temperature, white blood cell (WBC) count, the level of C-reactive protein (CRP), and interleukin-6 (IL-6) were measured for eleven patients undergoing THA and eight patients undergoing TKA. All the patients who underwent THA and TKA received a transfusion of 2 units of autologous blood but no transfusion with homologous blood, and the TKA surgery was performed without an air tourniquet. The first day after the surgery, there was no significant difference between the THA and TKA with respect to body temperature and CRP. However, there was a significant difference between the THA and TKA in WBC count (p < 0.05) and IL-6 (p < 0.01) on the first day after the surgery. In addition, there was a significant difference between the THA and TKA in IL-6 (p < 0.05) and CRP level (p < 0.05) on the seventh day after the surgery. The surgical stress of TKA was significantly larger than the surgical stress of THA. There may be more potential complications in the patients who underwent TKA than those who underwent THA.
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