Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome
Objectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a g...
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-04-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/2/e002808.full |
| _version_ | 1827965661380345856 |
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| author | Gillian A Hawker Eric Bohm James Stewart Deborah A Marshall Raj Sharma Jason Werle Peter Faris Linda J Woodhouse Bheeshma Ravi Paul Duffy Shannon Puloski Kelly Johnston Greg Abelseth Raul Kuchinad Tom Noseworthy John Donaghy C Allyson Jones James Powell Ian Stanaitis Michael J Dunbar Gillian A. Hawker Deborah A. Marshall Michael J. Dunbar C. Allyson Jones Linda J. Woodhouse Gordon Arnett Robert Balyk Jeffery Bury John Cinats Donald Dick D'Arcy Durand Lee Ekert Robert Glasgow Don Glasgow Gordon Goplen Catherine Hui Ben Herman Larry Hunka Hongxing Jiang William C. Johnson Frank Kortbeek Guy Lavoie Mitch Lavoie Paul K. Leung James Mahood Edward Masson Richard McLeod James McMillan Greg O’Connor David Otto Carlo Panaro Paulose Paul Gordon Russell Colleen Weeks Don Weber Andrea Woo Jane Squire Howden Anne-Marie Adachi Jessica Beatty Shakib Rahman Kelley De Souza Robert Korley Michael Monument Maureen O'Brien Ed Rendall Alex Rezansoff Scott Timmerman Tanya Reczek Jeffrey Depew Bukky Dada |
| author_facet | Gillian A Hawker Eric Bohm James Stewart Deborah A Marshall Raj Sharma Jason Werle Peter Faris Linda J Woodhouse Bheeshma Ravi Paul Duffy Shannon Puloski Kelly Johnston Greg Abelseth Raul Kuchinad Tom Noseworthy John Donaghy C Allyson Jones James Powell Ian Stanaitis Michael J Dunbar Gillian A. Hawker Deborah A. Marshall Michael J. Dunbar C. Allyson Jones Linda J. Woodhouse Gordon Arnett Robert Balyk Jeffery Bury John Cinats Donald Dick D'Arcy Durand Lee Ekert Robert Glasgow Don Glasgow Gordon Goplen Catherine Hui Ben Herman Larry Hunka Hongxing Jiang William C. Johnson Frank Kortbeek Guy Lavoie Mitch Lavoie Paul K. Leung James Mahood Edward Masson Richard McLeod James McMillan Greg O’Connor David Otto Carlo Panaro Paulose Paul Gordon Russell Colleen Weeks Don Weber Andrea Woo Jane Squire Howden Anne-Marie Adachi Jessica Beatty Shakib Rahman Kelley De Souza Robert Korley Michael Monument Maureen O'Brien Ed Rendall Alex Rezansoff Scott Timmerman Tanya Reczek Jeffrey Depew Bukky Dada |
| collection | DOAJ |
| description | Objectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.Methods In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.Results Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.Conclusions Although external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome. |
| first_indexed | 2024-04-09T17:36:51Z |
| format | Article |
| id | doaj.art-ec9d695506824cab8e9dde2cd32400c8 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-04-09T17:36:51Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-ec9d695506824cab8e9dde2cd32400c82023-04-17T18:30:06ZengBMJ Publishing GroupRMD Open2056-59332023-04-019210.1136/rmdopen-2022-002808Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome 0Gillian A Hawker1Eric Bohm2James Stewart3Deborah A Marshall4Raj Sharma5Jason Werle6Peter Faris7Linda J Woodhouse8Bheeshma Ravi9Paul DuffyShannon PuloskiKelly JohnstonGreg AbelsethRaul KuchinadTom Noseworthy10John Donaghy11C Allyson Jones12James Powell13Ian Stanaitis14Michael J Dunbar15Gillian A. HawkerDeborah A. MarshallMichael J. DunbarC. Allyson JonesLinda J. WoodhouseGordon ArnettRobert BalykJeffery BuryJohn CinatsDonald DickD'Arcy DurandLee EkertRobert GlasgowDon GlasgowGordon GoplenCatherine HuiBen HermanLarry HunkaHongxing JiangWilliam C. JohnsonFrank KortbeekGuy LavoieMitch LavoiePaul K. LeungJames MahoodEdward MassonRichard McLeodJames McMillanGreg O’ConnorDavid OttoCarlo PanaroPaulose PaulGordon RussellColleen WeeksDon WeberAndrea WooJane Squire HowdenAnne-Marie AdachiJessica BeattyShakib RahmanKelley De SouzaRobert KorleyMichael MonumentMaureen O'BrienEd RendallAlex RezansoffScott TimmermanTanya ReczekJeffrey DepewBukky DadaPartners for Health and Development in Africa (PHDA), Nairobi, KenyaWomen`s College Research Institute, Women`s College Hospital, Toronto, Ontario, CanadaDivision of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada1 Royal Marsden Hospital NHS Trust, London, UKCummings School of Medicine, University of Calgary, Calgary, Alberta, Canada5 Respiratory Medical Franchise, GlaxoSmithKline, Brentford, London, UK6 Department of Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, CanadaAnalytics (DIMR), Health Services Statistical & Analytic Methods, Alberta Health Services, Calgary, Alberta, CanadaDepartment of Public Health and Community Medicine, Tufts University, Phoenix, Arizona, USADivision of Orthopedic Surgery, Sunnybrook Holland Orthopedic and Arthritic Centre, Toronto, Ontario, CanadaUniversity of Calgary, Calgary, Alberta, CanadaUniversity College London Hospitals NHS Foundation TrustPhysical Therapy, University of Alberta, Edmonton, Alberta, Canada2Velindre Cancer Centre, Cardiff, UKWomen`s College Research Institute, Women’s College Hospital, Toronto, Ontario, CanadaDepartment of Surgery, Dalhousie University, Halifax, Nova Scotia, CanadaObjectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.Methods In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.Results Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.Conclusions Although external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.https://rmdopen.bmj.com/content/9/2/e002808.full |
| spellingShingle | Gillian A Hawker Eric Bohm James Stewart Deborah A Marshall Raj Sharma Jason Werle Peter Faris Linda J Woodhouse Bheeshma Ravi Paul Duffy Shannon Puloski Kelly Johnston Greg Abelseth Raul Kuchinad Tom Noseworthy John Donaghy C Allyson Jones James Powell Ian Stanaitis Michael J Dunbar Gillian A. Hawker Deborah A. Marshall Michael J. Dunbar C. Allyson Jones Linda J. Woodhouse Gordon Arnett Robert Balyk Jeffery Bury John Cinats Donald Dick D'Arcy Durand Lee Ekert Robert Glasgow Don Glasgow Gordon Goplen Catherine Hui Ben Herman Larry Hunka Hongxing Jiang William C. Johnson Frank Kortbeek Guy Lavoie Mitch Lavoie Paul K. Leung James Mahood Edward Masson Richard McLeod James McMillan Greg O’Connor David Otto Carlo Panaro Paulose Paul Gordon Russell Colleen Weeks Don Weber Andrea Woo Jane Squire Howden Anne-Marie Adachi Jessica Beatty Shakib Rahman Kelley De Souza Robert Korley Michael Monument Maureen O'Brien Ed Rendall Alex Rezansoff Scott Timmerman Tanya Reczek Jeffrey Depew Bukky Dada Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome RMD Open |
| title | Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| title_full | Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| title_fullStr | Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| title_full_unstemmed | Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| title_short | Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| title_sort | patient appropriateness for total knee arthroplasty and predicted probability of a good outcome |
| url | https://rmdopen.bmj.com/content/9/2/e002808.full |
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