Page 171 - The value of total hip and knee arthroplasties for patients

So far, the prediction of outcomes of THA and TKA proved to be disappointing.8,9 A systematic review by Hofstede et al.9 included 35 studies. It considered preoperative function, radiological osteoarthritis, ages, gender, BMI, comorbidity, pain and quality of life and investigated their association with postoperative improvement. The authors of the review concluded that overall there is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide whenTHA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups.9
In the absence of a valid prediction model to better select patients who will benefit
most from surgery, yet a need for more standardization, several sets of indication
criteria for THA or TKA are currently used in clinical practice. A systematic review
on such sets of indication criteria by Gademan et al.8 included 6 guidelines and 18
papers. This review identified 12 THA, 10 TKA and 2 THA/TKA sets of indication
criteria. Indication criteria concerning THA/TKA consisted of the following domains:
pain, function, radiological changes and failed conservative therapy. Specific cut-off
values or ranges to support the decision for surgery were often not stated and the
level of evidence was low. This review concluded that indication criteria for THA/
TKA used in clinical practice are based on limited evidence.8 9
All of these findings clearly indicated that more empirical research is needed, especially regarding the development of prediction models, including domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis and the patients’ life expectancy. This would thus imply the ability to distinguish different trajectories of outcome in individual patients, consensus on cut-off values for clinical success and failure8
Moreover,more research into unknown factors that are not yet taken into account in any of the models so far is needed. Such research would probably include qualitative approaches, in order to elicit relevant concepts that are not included in any sets of PROMS so far.
General Discussion
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