Total Knee Arthroplasty Clinical Trial
Official title:
Retrospective Analysis of Patient Outcome Questionnaire Following Primary Knee Replacement
The intention is to explore whether there are factors which help us to understand why some
patient outcomes are not successful and identify prediction factors for progression. It will
also assess the available outcomes pre- and post-surgery may explore prediction tools for
good/poor progression and improve the patient's selection, patient preparation or timing for
surgery.
The focus of this project is exploring outcomes post-primary total knee arthroplasty (TKA)
using the available pre/post-operative Oxford Knee Score (OKS), University of California Los
Angeles (UCLA) Activity Score, EQ-5D General Health Questionnaire, Visual Analogue (VAS) for
pain, age and smoking status data, and correlations between these data and post operation
patient satisfaction.
Knee osteoarthritis (OA) is a major cause of disability around the world; it is the most
common chronic condition in primary care in the UK. By 2030 it is predicted to be the
greatest cause of disability in the general population. An effective end-stage treatment for
knee OA is knee-replacement surgery.
In England and Wales, the number of knee-replacement procedures recorded by the National
Joint Registry in 2013 was 91,703, which represents an increase of 0.9 % over 2012. The data
analysis by the National Joint Registry and the Office of National Statistics suggests that,
by 2030, primary TKAs will increase by 117% from the 2012 level. Subsequently, TKA revision
surgeries are expected to increase incrementally by 332%.
Post-TKA, 75-85% of patients report satisfaction with surgery outcomes, while the remaining
15-25% are dissatisfied. Total knee arthroplasty's success has traditionally been evaluated
from the surgeon's perspective, e.g. the presence of surgical complications or implant
survival. This is gradually changing to involve the patient in measuring health outcomes and
decision-making processes. Patient-reported outcome measures (PROMs) have evolved to explore
patient perspectives by monitoring the quality of care in health organizations and conducting
clinical trial outcomes. National Health Service used PROMs to measures health gain in
patients undergoing hip replacement, knee replacement, varicose vein and groin hernia surgery
in England, based on responses to questionnaires before and after surgery.
This retrospective cohort study will investigate outcomes 1 and 3 years post-TKA, and factors
that may predict good/poor progression based on previously gathered data, which may minimize
the effect of prospective data collection bias. The study will explore accurate prediction
factors of post-TKA satisfaction at Stockport NHS Foundation Trust operates at Stepping Hill
Hospital which is a busy District General Hospital, with a large orthopaedic department.
Outcome following knee replacement surgery is closely monitored and matches the best
performing units in the UK. Potentially, reliable outcome prediction could, however, improve
patient selection for surgery, as appropriate timing for surgery depends on patient symptoms
and efficient patient preparation for surgery if it is to be cost-effective. Accurate
preoperative prediction is crucial to minimize the potential for unrealistic expectations
which may improve their satisfaction.
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