Clinics in geriatric medicine
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Clin. Geriatr. Med. · Aug 2012
ReviewPatient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure.
Although the effectiveness of THA and TKA as interventions for end-stage degenerative joint disease has been well established, the use of instruments that measure outcome from the patient's perspective are relatively poorly investigated. Considering the increasing prevalence, associated risks, and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need to consider a number of factors when selecting a "good" patientreported outcome for use in their TJA patients. ⋯ It is clear that further studies are required, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind the practical issues and psychometric limitations of these instruments when applied to THA and TKA patients.
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Clin. Geriatr. Med. · Aug 2012
ReviewHealth-related quality of life after total joint arthroplasty: a scoping review.
A scoping review was completed to summarize the change in health status after THA and TKA. Although a recent study has performed a systematic review of functional recovery after THA,(61) we reviewed a broad topic of HRQL changes after total joint arthroplasty. This scoping review was not restricted by study design; however, the majority of studies were prospective single group, observational studies so that change over time could be reported. ⋯ Because a number of HRQL measures are used to evaluate the outcomes after total joint arthroplasties, comparisons can be challenging. This review summarized published findings to help place the magnitude of change seen with total joint arthroplasty in perspective. Changes seen with HRQL are one aspect of evaluating outcomes from a patient perspective; however, recovery is a complex concept(64) that needs many clinical and research-oriented measures to evaluate the full spectrum of recovery.
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Clin. Geriatr. Med. · Aug 2012
ReviewMinimally invasive total hip and knee arthroplasty-implications for the elderly patient.
Overall, it can be concluded that because of the aging society, an increasing number of elderly people will be undergoing total joint arthroplasty. These elderly patients have an increased risk for serious complications after primary THA or TKA. However, the overall complication rates remain low. ⋯ MIS total joint arthroplasty aims at decreasing the surgical incision and minimizing damage to the underlying soft tissue to accelerate postoperative recovery and an earlier return to normal function. A critical look at the literature on MIS shows that the term minimally invasive is often used for a conventional total joint arthroplasty performed through a smaller skin incision. Research has shown promising results of using MIS in elderly patients; it seems that compared with younger patients, elderly patients benefit more from a minimally invasive approach.
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Patient satisfaction is an important outcome measurement in TKA/THA surgery. Patient satisfaction can be evaluated from 2 perspectives, determinants of satisfaction and components of satisfaction.(5) In total joint arthroplasty, improvements in satisfaction can be achieved by examining these perspectives. Patient satisfaction is one of the many PROMs used in orthopedic surgery and is an integral part of the growing sentiment to evaluate surgery from the patient's perspective as well as from the surgeon's. The importance of measuring outcomes from the patient perspective is integral to today's patient-centered models of care.
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Total joint arthroplasty is a safe and highly effective treatment for moderate to severe osteoarthritic symptoms and other causes of joint derangement in the elderly population. Significant improvements in pain, function, and quality of life are nearly universal, with a low rate of complications and adverse outcomes. ⋯ As with all patients undergoing TJR, patients should be prophylactically treated for infection and thromboembolism and carefully followed for the development of these potential complications as well as fracture, hip dislocation, and neurovascular dysfunction. Postoperative delirium may be minimized and prophylactically treated in appropriate elderly patients to maximize recovery and promote safety.