Page 170 - The value of total hip and knee arthroplasties for patients

Chapter 9
done by keeping in touch with them several times per year by sending them updates (newsletters) and offering them the opportunity to use pen-and-paper questionnaires beside an Internet-based structure.
A weakness however was the considerable proportion of patients who were not invited to participate in the study.This finding suggests that more effort could be put in supporting the hospitals to inform all eligible patients timely about the study. A challenge in this respect Is the observation that , of those who were invited preoperatively, relatively many could not complete the preoperative questionnaires as their surgery was planned shortly thereafter.
As during the course of the LOAS study the collection of the mandatory basic set of PROMs became more and more implemented and largely executed electronically by means of software provided by specialized companies in the Netherlands, collecting the additional LOAS data became more easy over the years. However, as each hospital employed a unique strategy to collect these PROMs, with different software systems, adding the gathering of the LOAS data to the individual strategies of each hospital still appeared to be time consuming. In addition, the time points 3 months (THA) and 6 months (TKA) as imposed by the NOV did not completely coincide with the time points of the LOAS, warranting the need for amendments to the original study protocol. Finally, despite the streamlining with the mandatory data collecting preoperatively and at 3 or 6 and 12 months, gathering data at extra time points during after 1 year of follow-up will remain necessary over the next years as one of the strengths of the LOAS lies in the long-term follow up.
Predicting recovery after THA or TKA
Accurate prediction of patients who will and will not benefit fromTHA orTKA is very important in order study to prevent unnecessary (low-value) care.We examined one possible predictor of outcome of THA and TKA, i.e. preoperative radiographic abnormalities, with the results of our study showing that improvements over time were greater in patients with more severe radiographic OA. The difference was statistically significant for a number of clinical outcomes in THA patients, but not in TKA patients. Overall, our results are in line with the literature, with the majority of studies concluding that more severe radiographic OA preoperatively is associated with better outcomes in THA or TKA.5-7
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