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Judge A.,University of Oxford | Judge A.,University of Southampton | Arden N.K.,University of Oxford | Arden N.K.,University of Southampton | And 7 more authors.
Rheumatology (United Kingdom) | Year: 2012

Objective. To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery.Methods. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome.Results. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than those with OA; deprivation-those living in poorer areas had worse outcomes; and anxiety/depression-worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome.Conclusion. This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient's expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Source


Judge A.,University of Oxford | Arden N.K.,University of Oxford | Price A.,University of Oxford | Glyn-Jones S.,University of Oxford | And 6 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011

We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question. Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman's rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care. ©2011 British Editorial Society of Bone and Joint Surgery. Source


Judge A.,University of Oxford | Judge A.,University of Southampton | Batra R.N.,University of Oxford | Thomas G.E.,University of Oxford | And 12 more authors.
Osteoarthritis and Cartilage | Year: 2014

Objectives: To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery. Design: Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (EPOS) (n=1431); EUROHIP (n=1327); Elective Orthopaedic Centre (n=2832); and St. Helier (n=787). The exposure of interest was pre-operative BMI. Confounding variables included: age, sex, SF-36 mental health, comorbidities, fixed flexion, analgesic use, college education, OA in other joints, expectation of less pain, radiographic K&L grade, ASA grade, years of hip pain. The primary outcome was the Oxford Hip Score (OHS). Regression models describe the association of BMI on outcome adjusting for all confounders. Results: For a 5-unit increase in BMI, the attained 12-month OHS decreases by 0.78 points 95%CI (0.27-1.28), P-value 0.001. Compared to people of normal BMI (20-25), those in the obese class II (BMI 35-40) would have a 12-month OHS that is 2.34 points lower. Although statistically significant this effect is small and not clinically meaningful in contrast to the substantial change in OHS seen across all BMI groupings. In obese class II patients achieved a 22.2 point change in OHS following surgery. Conclusions: Patients achieved substantial change in OHS after THR across all BMI categories, which greatly outweighs the small difference in attained post-operative score. The findings suggest BMI should not present a barrier to access THR in terms of PROMs. © 2014 Osteoarthritis Research Society International. Source


Kamat Y.D.,Elective Orthopaedic Center
The journal of knee surgery | Year: 2013

Following the success of computer navigation in producing consistently accurate alignment, the focus has shifted to use of these techniques for soft tissue assessment during total knee replacement (TKR). We undertook a prospectively randomized clinical study to compare two methods of tissue balancing in TKR. One method, called bone referencing (BR) employed independent cutting of the femur and tibia followed by subjective assessment with trial prostheses and soft tissue release as deemed necessary. The other method, termed ligament balancing (LB), involved cutting the tibia first and titration of tissue balance and alignment parameters to guide femoral cuts. Our total sample comprised 77 subjects with 80% statistical power. To assess tissue balance we used (a) coronal laxity testing and (b) computer navigation generated passive knee range of movement graphs. The graphical assessment was validated with coronal laxity testing. There was no difference between the resultant tissue balances achieved. However, correlation with preoperative status revealed the LB technique to show better results in a smaller subgroup of knees with greater preoperative tissue imbalance. We advocate variation of tissue balancing technique to suit the individual knee, based on preoperative assessment, to achieve an optimal result in all TKR. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. Source


El Shafie S.,Elective Orthopaedic Center | Craik J.,Epsom And St Helier University Hospitals | Day A.M.,Epsom And St Helier University Hospitals | Desborough J.,Epsom And St Helier University Hospitals | Twyman R.,Epsom And St Helier University Hospitals
Ambulatory Surgery | Year: 2014

Declaration: The authors would like to declare that this study has not been published or being reviewed by other journals. Retention of new information may be impaired during recovery from general anaesthesia. Patients are likely to be anxious if they cannot recall information conveyed at the surgeons' postoperative visit. Previous studies have shown evidence of short-term memory impairment after GA. Patients undergoing day case knee arthroscopy under general anaesthesia were told five random words and three diagnostic findings from their operation, by the surgeon prior to discharge. The patients were telephoned the following day to test their recall of words and diagnostic findings, with a maximum possible score of eight. 96 patients were available for the telephone follow-up. The patients were grouped according to the interval between the end of anaesthesia and the time the information was given to them. For knee arthroscopy day cases it appears that, allowing as much time as possible after anaesthesia, at least two hours if possible, before reviewing a patient in the recovery area will likely enhance his/her later recall of the clinical information, potentially setting patient expectations at the appropriate level and improving compliance with postoperative rehabilitation. For the surgeons' post-operative visit to be valuable to the patient, it should take place at least two hours following cessation of anaesthesia. It is advisable to endorse verbal communication with written information. Source

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