Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome.
Knee Osteoarthritis
Orthopedic Procedures
Osteoarthritis, Knee
Outcomes research
Journal
RMD open
ISSN: 2056-5933
Titre abrégé: RMD Open
Pays: England
ID NLM: 101662038
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
19
10
2022
accepted:
22
03
2023
medline:
19
4
2023
entrez:
17
4
2023
pubmed:
18
4
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 37068914
pii: rmdopen-2022-002808
doi: 10.1136/rmdopen-2022-002808
pmc: PMC10111922
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : CIHR
ID : MOP-312807
Pays : Canada
Investigateurs
Gillian A Hawker
(GA)
Deborah A Marshall
(DA)
Eric Bohm
(E)
Michael J Dunbar
(MJ)
Peter Faris
(P)
C Allyson Jones
(C)
Tom Noseworthy
(T)
Bheeshma Ravi
(B)
Linda J Woodhouse
(LJ)
Gordon Arnett
(G)
Robert Balyk
(R)
Jeffery Bury
(J)
John Cinats
(J)
Donald Dick
(D)
D'Arcy Durand
(D)
Lee Ekert
(L)
Robert Glasgow
(R)
Don Glasgow
(D)
Gordon Goplen
(G)
Catherine Hui
(C)
Ben Herman
(B)
Larry Hunka
(L)
Hongxing Jiang
(H)
William C Johnson
(WC)
Frank Kortbeek
(F)
Guy Lavoie
(G)
Mitch Lavoie
(M)
Paul K Leung
(PK)
James Mahood
(J)
Edward Masson
(E)
Richard McLeod
(R)
James McMillan
(J)
Greg O'Connor
(G)
David Otto
(D)
Carlo Panaro
(C)
Paulose Paul
(P)
Gordon Russell
(G)
Colleen Weeks
(C)
Don Weber
(D)
Andrea Woo
(A)
Jane Squire Howden
(JS)
Anne-Marie Adachi
(AM)
Jessica Beatty
(J)
Shakib Rahman
(S)
Greg Abelseth
(G)
Kelley De Souza
(K)
John Donaghy
(J)
Paul Duffy
(P)
Kelly Johnston
(K)
Robert Korley
(R)
Raul Kuchinad
(R)
Michael Monument
(M)
Maureen O'Brien
(M)
James Powell
(J)
Shannon Puloski
(S)
Ed Rendall
(E)
Alex Rezansoff
(A)
Raj Sharma
(R)
James Stewart
(J)
Scott Timmerman
(S)
Jason Werle
(J)
Tanya Reczek
(T)
Jeffrey Depew
(J)
Bukky Dada
(B)
Ian Stanaitis
(I)
Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: GAH has received research support as the Sir John and Lady Eaton Professor and Chair of Medicine, Department of Medicine, University of Toronto. DM has received salary and research support as a Canada Research Chair and as the Arthur J.E. Child Chair Professor. All other authors declare no other relationships or activities that could appear to have influenced the submitted work.
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