Are pain and function better measures of outcome than revision rates after TKR in the younger patient?
Are pain and function better measures of outcome than revision rates after TKR in the younger patient?
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.
knee, arthroplasty, survival, outcome, young age
196-199
Price, A.J.
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Longino, D.
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Rees, J.
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Rout, R.
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Pandit, H.
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Javaid, K.
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Arden, N.
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Cooper, C.
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Carr, A.J.
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Dodd, C.A.F.
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Murray, D.W.
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Beard, D.J.
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4 February 2010
Price, A.J.
d38e827f-588c-47f8-9590-ce8790423e2c
Longino, D.
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Rees, J.
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Rout, R.
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Pandit, H.
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Javaid, K.
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Arden, N.
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Cooper, C.
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Carr, A.J.
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Dodd, C.A.F.
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Murray, D.W.
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Beard, D.J.
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Price, A.J., Longino, D., Rees, J., Rout, R., Pandit, H., Javaid, K., Arden, N., Cooper, C., Carr, A.J., Dodd, C.A.F., Murray, D.W. and Beard, D.J.
(2010)
Are pain and function better measures of outcome than revision rates after TKR in the younger patient?
The Knee, 17 (3), .
(doi:10.1016/j.knee.2009.09.003).
Abstract
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.
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Published date: 4 February 2010
Keywords:
knee, arthroplasty, survival, outcome, young age
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Local EPrints ID: 150767
URI: http://eprints.soton.ac.uk/id/eprint/150767
ISSN: 0968-0160
PURE UUID: 380fe6c3-e930-4488-b7a9-079b50a35e56
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Date deposited: 06 May 2010 11:10
Last modified: 18 Mar 2024 02:44
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Author:
A.J. Price
Author:
D. Longino
Author:
J. Rees
Author:
R. Rout
Author:
H. Pandit
Author:
K. Javaid
Author:
A.J. Carr
Author:
C.A.F. Dodd
Author:
D.W. Murray
Author:
D.J. Beard
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