Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.853
Peer-review started: October 3, 2023
First decision: October 9, 2023
Revised: October 18, 2023
Accepted: November 13, 2023
Article in press: November 13, 2023
Published online: December 18, 2023
Patient report outcome measures (PROMs) quantitatively assess patient’s symptoms, function and quality of life (QoL). It is known severe osteoarthritis (OA) can be alleviated by joint replacement. To what extent these procedures improve symptoms, function, and QoL can vary depending on the joint, type of procedure, and patient co-factors. Additionally, it is important to maintain a contemporary assessment of the impacts of current surgical practice. The significance of this study is it is the first study of its type to assess the impact of total hip replacements (THR) and total knee replacements (TKR) using a large range of PROMS, in a modern cohort, which also provides sub-analysis on the impact of implant type and obesity.
Previous literature on the impact of THR and TKR is either out-of-date or very narrow in it’s scope. As an orthopedic surgeon, it is important to predict the impact of these procedures, in order to tailor management for each patient. Therefore, knowing the impact of modern arthroplasty on symptoms, function, and QoL should be explored and available in the literature. Additionally, factors such as obesity can significantly deter surgeons from offering surgery to patients due to known peri-operative risks without fully appreciating the long term benefits patients can achieve. It is therefore our motivation to explore if THR and TKR can offer good outcomes to patients and begin to explore which patient, implant and operative factors can lead to the best outcomes or pose particular risks. Future research can use the approach of this study identify which of the factors should be considered when counseling patients with severe OA.
The primary objective of this study was to explore patient reported outcome measures in patients before and after total hip and knee replacement procedures. This was achieved with a sufficiently powered study to detect statistical and clinic significance, and comparison of the two groups was also achieved. Future research can monitor the impact of these procedures as surgical technology continues to improve. Additionally, further research can proceed determine which other factors impact patient outcomes following joint arthroplasty.
This study is a pragmatic clinic study of real time clinical practice. The PROMs used in this study are routinely collected in clinical practice and some contribute to data collected by the United Kingdom National Joint Registry. The range of PROMs, although used in a different context, have been utilised in the MD thesis of the senior author. These studies shared similar methodologies to the studies cited. The value of using a range PROMs could be incorporated into national joint registries to allow for research which is highly powered and diverse in its assessment of outcomes.
This study contributes to the modern literature by demonstrating that hip and knee arthroplasty are equally effective at treating the symptoms of severe OA, and equally successful at improving patient function and QoL. This study reflects more recent clinical practice, more comparable clinical cohorts and a broader range of PROMS than the current literature offers. These results can be built upon to establish which other factors impact patient outcomes following joint arthroplasty.
This study proposes the theory that hip and knee OA can be equally symptomatic in severity, and limiting in QoL and function to patients. Furthermore, arthoplasty is equally effecting at improving these outcomes, regardless of the method used (cruciate retaining vs posterior stabilized, cemented vs uncemented). This study compares established outcome measures for established surgical procedures. Whilst no new or novel methodology is proposed, a comprehensive assessment has been demonstrated for the first time in the literature.
Broadly speaking, research should aim to establish which patient, operative and implant factors can be optimised in order to produce the best outcomes, and mitigate risk, for patient undergoing joint arthroplasty for OA.