Identification of Potentially High-risk Patients on the Basis of PROMs in a Certified Centre for Joint Replacement (EndoProthetikZentrum) Using the Example of Primary Knee Arthroplasty

Abstract

Background The subjective evaluation of the patient’s state of health with the help of Patient-reported Outcome Measurements (PROMs) provides valuable information for assessing the treatment outcome and for treatment planning. However, the use of PROMs in the field of arthroplasty is not mandatory, so that there is a lack of standardised recording and interpretation. The present study aims to identify patients, who have not achieved the intended treatment goals with regard to pain, function and quality of life after total knee arthroplasty, more easily in the future on the basis of postoperative PROMs.

Material and Methods Data collection (for 3-month postoperative follow-up) included a standardised clinical follow-up (NU) and a questionnaire of different PROMs (Oxford Knee Score [OKS], OKS Pain Score [OKSS] and EndoCert Risk Score [ERS]). During the specialist follow-up examination, it was decided whether further medical therapy had to be initiated. Accordingly, patients were grouped into four post-treatment categories (NU not required/further diagnostics/new prescription/revision required).

Results For individual scores and questions, there were significant differences between the respective groups of consequences resulting from the follow-up examination. The OKS, OKS Pain Score and the ERS are suitable for detecting thresholds to determine the need for a follow-up examination. The postoperative thresholds of the scores are 24 for the OKS total score, 52 for the OKS pain score and 4 for the ERS pain intensity score.

Conclusion In the initial three months after knee arthroplasty, certain PROMs are suitable for identifying patients for whom further diagnostics and therapy are indicated. In particular, the OKS and the pain intensity score of the ERS are suitable for detecting a potentially unfavourable development in rehabilitation after total knee arthroplasty.

Keywords

total knee arthroplasty - EndoCert - follow-up study - Oxford Knee Score - Euroquol-5D

• Literatur

• 1 Hostettler S, Kraft E, Bosshard C. Patient-reported outcome measures: die Patientensicht zählt. Schweiz Ärzteztg 2018;
• 2 Hamilton DF, Giesinger JM, Giesinger K. It is merely subjective opinion that patient-reported outcome measures are not objective tools. Bone Joint Res 2017; 6: 665-666
• 3 Ethgen O, Bruyère O, Richy F. et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86: 963-974
• 4 Beard DJ, Harris K, Dawson J. et al. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 2015; 68: 73-79
• 5 Judge A, Arden NK, Kiran A. et al. Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery. J Bone Joint Surg Br 2012; 94: 412-418
• 6 Keurentjes JC, van Tol FR, Fiocco M. et al. Patient acceptable symptom states after totalhip or knee replacement at mid-term follow-up: Thresholds of the Oxford hip and knee scores. Bone Joint Res 2014; 3: 7-13
• 7 Rolfson O, Eresian Chenok K, Bohm E. et al. Patient-reported outcome measures in arthroplasty registries. Acta Orthop 2016; 87 (Suppl. 01) 3-8
• 8 EndoCert. Zertifizierung von endoprothetischen Versorgezentren in Deutschland; eine Initiative der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC) mit Unterstützung der Arbeitsgemeinschaft Endoprothetik (AE). Haas H. Stuttgart, New York: Thieme; 2013
• 9 Murray DW, Fitzpatrick R, Rogers K. et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89: 1010-1014
• 10 Harris KK, Price AJ, Beard DJ. et al. Can pain and function be distinguished in the Oxford Hip Score in a meaningful way? : an exploratory and confirmatory factor analysis. Bone Joint Res 2014; 3: 305-309
• 11 Harris K, Dawson J, Doll H. et al. Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 2013; 22: 2561-2568
• 12 Greiner W, Claes C, Busschbach JJV. et al. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 2005; 6: 124-130
• 13 Rolfson O, Bohm E, Franklin P. et al. Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87 (Suppl. 01) S9-S23
• 14 Osmanski-Zenk K, Klinder A, Ellenrieder M. et al. Identifikation von potenziellen Risikopatienten auf Basis von PROMs in einem zertifizierten EndoProthetikZentrum am Beispiel der Hüftendoprothetik. Z Orthop Unfall 2021;
• 15 Copay AG, Subach BR, Glassman SD. et al. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007; 7: 541-546
• 16 Cohen J. Quantitative Methods in Psychology: A Power Primer. Psychol Bull 1992; 112: 155-159
• 17 Gignac GE, Szodorai ET. Effect size guidelines for individual differences researchers. Pers Individ Dif 2016; 102: 74-78
• 18 Clement ND, Macdonald D, Burnett R. Predicting patient satisfaction using the Oxford knee score: where do we draw the line?. Arch Orthop Trauma Surg 2013; 133: 689-694
• 19 Mikkelsen M, Gao A, Ingelsrud LH. et al. Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements. J Clin Epidemiol 2020; 132: 18-25
• 20 Petersen CL, Kjærsgaard JB, Kjærgaard N. et al. Thresholds for Oxford Knee Score after total knee replacement surgery: a novel approach to post-operative evaluation. J Orthop Surg Res 2017; 12: 89
• 21 Krueger DR, Leopold VJ, Schroeder JH. et al. Correlation of the Subjective Hip Value with Validated Patient-Reported Outcome Measurements for the Hip. J Clin Med 2020; 9: 2179
• 22 Jiang Y, Sanchez-Santos MT, Judge AD. et al. Predictors of Patient-Reported Pain and Functional Outcomes Over 10 Years After Primary Total Knee Arthroplasty: A Prospective Cohort Study. J Arthroplasty 2017; 32: 92-100.e2
• 23 Halawi MJ, Jongbloed W, Baron S. et al. Patient-Reported Outcome Measures are not a Valid Proxy for Patient Satisfaction in Total Joint Arthroplasty. J Arthroplasty 2020; 35: 335-339
• 24 Judge A, Arden NK, Cooper C. et al. Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford) 2012; 51: 1804-1813
• 25 Osmanski-Zenk K, Oskina A, Bader R. et al. Machbarkeitsstudie zum Einsatz verschiedener Patient-related Outcome Measurements in einem zertifizierten EndoProthetikZentrum. Z Orthop Unfall 2019; 157: 501-509