Page 169 - The value of total hip and knee arthroplasties for patients

This thesis focussed on the process of recovery after THA and TKA. It evaluated the feasibility of collecting PROMs including measures of activities and participation before and after joint surgery, the role of radiographic features as predictors of recovery and patients’ preoperative expectations of recovery and their fulfilment after THA and TKA.
The expression of the beneficial effects of surgery in terms of PROMs is in line with the focus in health care being more and more on its outcomes in terms of value for patients. Thereby, a shift towards outcome measurements addressing what is most relevant for patients is taking place.1 According to the three-tiered value-based health care model of Michael Porter, apart from health status achieved or retained (Tier 1) and sustainability of health (Tier 3), the process of recovery (Tier 2) is of utmost importance.1 This includes the time to recovery and time to return to normal activities, and disutilities of care or the treatment process. Recently, based on this model, specifically for hip and knee osteoarthritis the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Hip & Knee Osteoarthritis was published.2 The studies described in this thesis were initiated before this latter publication, but include similar outcome dimension.
Collecting PROMS before and after TKA and THA
Based on the results of the LOAS (Leiden Orthopaedics Outcome of OsteoArthritis
Study) we concluded that the prospective collection of a comprehensive set of
PROMs can be done relatively successfully alongside a national arthroplasty register
(Dutch Arthroplasty Register, Landelijke Registratie Orthopedische Implantaten, 9 LROI) (Chapter 2). The data collection done in the LOAS differed from the
set of PROMs imposed by the Dutch Orthopaedic Association (Nederlandse Orthopaedische Vereniging, NOV) and are thus mandatory for orthopaedic surgeons in The Netherlands. The LOAS data collection was more extensive, as it included outcome measures on the level of societal participation and health care usage, and it was more prolonged (longer than 12 months).
Despite the extent of the data collection, the participation rates were fairly comparable to those reported for some international registries3 and those recently reported for the mandatory set of PROMS inThe Netherlands.4 The relatively high response rates, also during follow-up and despite the extent of the questionnaires, could probably be in part explained by our efforts to motivate patients.This was
General Discussion
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