Are pain and function better measures of outcome than revision rates after TKR in the younger patient?
| Autor: | D. Longino, C. A. F. Dodd, Andrew Price, Nigel K Arden, Jonathan Rees, Cyrus Cooper, D W Murray, K. Javaid, Hemant Pandit, R Rout, Andrew Carr, David J Beard |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Reoperation musculoskeletal diseases medicine.medical_specialty medicine.medical_treatment MEDLINE Osteoarthritis Outcome (game theory) medicine Clinical endpoint Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Survival rate Survival analysis business.industry Gold standard Age Factors Recovery of Function Middle Aged medicine.disease Arthralgia Survival Analysis Arthroplasty humanities Surgery Physical therapy Female business |
| Zdroj: | The Knee. 17:196-199 |
| ISSN: | 0968-0160 |
| Popis: | Revision is the gold standard outcome measurement for survival analyses of orthopaedic implants but reliance on revision as an endpoint has been recently questioned. This study, that assesses long-term outcome in a specific group of patients who had undergone total knee replacement (TKR) for osteoarthritis, highlights the main problems facing modern survival analyses. Minimum 12-year survival and outcome data were reviewed for a series of sixty patients under the age of 60 years (mean age 55.4 years) who underwent total knee replacement (TKR) for osteoarthritis. The patients are a subgroup from a larger consecutive series of 1429 patients who underwent TKR between 1987 and 1993 at a single institution. Whilst the main study aim was to compare outcome of TKR using different endpoints, the outcome of TKR in this younger subpopulation could also be investigated. With revision as the primary endpoint the survival for TKR was 82.2% (95% CI 17.3). The mean OKS at follow-up (mean 15.7 years) was 30.9. However, many of the 82% of patients who did not undergo revision had a less than satisfactory outcome. 41% of these patients reported modest or severe pain (using the OKS) at final follow-up. A combined endpoint including revision, poor function and significant pain drastically reduced the survival rate for the operation. Survival based on revision alone provides an acceptable but inaccurate impression of outcome in younger TKR patients (under 60 years). A true representation of the success of TKR should include pain and function as endpoints. |
| Databáze: | OpenAIRE |
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