Page 19 - The value of total hip and knee arthroplasties for patients

of THA and 11-20% TKA patients are dissatisfied after surgery. Unfavourable pain 1 outcome was reported in 9% or more of patients after hip and about 20% of
patients after knee replacement. Since patient-perceived outcomes after THA and
TKA are lower than implant survival rates, there is a growing recognition of the
importance of the collection of patient-reported outcomes (PROMs) next to survival data within orthopedic arthroplasty registers.31-36
Currently, there are numerous examples of the registration of PROMs alongside or thopedic implant registries in Europe (Sweden, UK, Norway)37,38, Nor th and New Zealand.39
More and more it is acknowledged that PROMs should cover the domains of functioning that are relevant for OA patients as described in ICF core sets for OA (ICF, 2015). Recently the International Consortium for Health Outcomes Measurements (ICHOM) published a data collection reference guide with specific PROMs that should be included in joint arthroplasty registers35.The ICHOM Standard Set for Hip & Knee OA outcomes comprises the hip or knee functional status (HOOS-PS or KOOS-PS), pain (numeric or VAS scales), Quality of life (either the EQ-5D-3L, VR-12 or SF-12), work status (no specific questionnaire) and satisfaction with results (no specific questionnaire).35
Predictors of recovery after THA and TKA
Predictors of outcomes of THA and TKA in terms of worse recovery of hip or knee pain and/or function include higher age, female sex, morbid obesity (BMI >40), worse physical, mental and social functioning, multiple joint involvement and comorbidity.6 The possible association between outcomes after THA and TKA and preoperative radiographic severity has been addressed repeatedly in the literature with conflicting results. 31,40-43 Although the results of most of the studies show some similarities, the designs of the studies are heterogeneous which makes it difficult to compare.
Fulfilment of expectations regarding return to normal activities after THA and TKA
With respect to dissatisfaction, evidence suggests that dissatisfaction seen in 10-20% of patients afterTHA orTKA is (at least partly) related to patients’ expectations that are not fulfilled.44 Treatment expectancy is defined as “improvements that clients believe will be achieved”.45 Several studies have assessed fulfilment of patients expectations regarding THA and/or TKA, however the majority only addressed a small selection of items (e.g. only expectations regarding pain), while evidence
General introduction
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