Use of patient-reported THR, TKR outcomes helps surgeons identify who will do poorly

VIENNA — Following lower limb total joint arthroplasty procedures designed to alleviate pain and restore function, some patients still have poor outcomes. Orthopaedists should know who might fall into that category so they can identify better interventions, and patients should have access to that information to decide what their best treatment options are, an investigator from Bristol, England, said.

According to results of a patient-based questionnaire used by research assistant Vikki Wylde and her colleagues, poor outcomes occurred in 13% of patients after total hip replacement (THR), 17% after total knee replacement (TKR) and 45% after patellar resurfacing. They studied these procedures and others at about 2 years postoperatively.

“The main message from this study is that, regardless of the joint replacement operation, some patients will experience a poor outcome after surgery. It is important that surgeons are aware that some patients will continue to experience chronic joint pain and disability after surgery so they can inform patients preoperatively about this risk,” Wylde told Orthopaedics Today Europe. She presented the findings at the 10th EFORT Congress, here.

Validated measures

Wylde and colleagues sent questionnaires to 3,125 patients treated consecutively at their center from January 2004 and April 2006 to assess pain, disability and other problems at 28 months, mean. Patients surveyed had undergone THR, hip resurfacing, TKR, unicompartmental knee replacement or patellar resurfacing.

The questionnaire included such validated outcome measures as the WOMAC score, the Knee Injury and Osteoarthritis Outcome Score, the Hip Dysfunction and Osteoarthritis Outcome Score and a validated form to assess satisfaction.

Of the 2,085 patients who responded, 42% were men. The patients’ mean age was 67 years.

Poor outcomes

On a 0 to 100 scale for the validated outcome measures used, Wylde scored 100 as an excellent outcome, 51 to 99 as a good-to-fair outcome and 50 or less as a poor outcome.

Poor outcomes were more prevalent among patellar resurfacing patients with 31% reporting pain, 35% reporting poor functional outcomes and 67% reporting poor hip-related quality of life on the questionnaire. The lowest prevalence of poor outcomes was in the hip resurfacing group. By comparison, their rates of a poor outcome were 4%, 4% and 12% for pain, function and hip-related quality of life, respectively.

Investigators found it interesting that a percentage of all these patients experienced a poor outcome following surgery.

“This finding ties in with the wider surgical literature, which has found that a considerable percentage of patients experience chronic post-surgical pain after a whole range of different operations, from breast surgery to inguinal hernia repair. This lends support to the notion that it may be patient factors, such as central pain sensitization, which is contributing to chronic pain after surgery,” Wylde told Orthopaedics Today Europe.

The cross-sectional nature of the survey used at only one follow-up time point was among the study’s limitations, she said.

David Beard, FRCS, from Oxford, England, asked during the paper’s discussion on what clinicians should focus.

“I think we actually need new outcome measures, more individualized measures,” Wylde said.

Reference:
Wylde V, Blom A, Dieppe P, et al. Prevalence of poor patient-reported outcomes after lower limb joint replacement. Paper F185. Presented at the 10th EFORT Congress. 3-6 June 2009. Vienna.