{"id":3954,"date":"2013-04-23T00:00:00","date_gmt":"2013-04-23T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/which-patients-are-most-likely-to-benefit-from-total-joint-arthroplasty\/"},"modified":"2023-06-14T19:32:25","modified_gmt":"2023-06-14T23:32:25","slug":"which-patients-are-most-likely-to-benefit-from-total-joint-arthroplasty","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/which-patients-are-most-likely-to-benefit-from-total-joint-arthroplasty\/","title":{"rendered":"Which patients are most likely to benefit from total joint arthroplasty?"},"content":{"rendered":"<p><strong>Objective<\/strong> &#x2014; To evaluate patient predictors of &apos;good outcome&apos; following total joint arthroplasty (TJA).<\/p>\n<p><strong>Methods<\/strong> &#x2014; A population cohort with hip\/knee arthritis (osteoarthritis, OA; inflammatory arthritis, IA) aged 55+ years was recruited (1996-98; baseline) and assessed annually (demographics, troublesome joints, health status and overall hip\/knee arthritis severity [WOMAC]). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as a WOMAC summary score improvement &#x2265; the Minimal Important Difference (MID = 0.5 SD mean change). Logistic regression and Akaike&apos;s Information Criterion determined the optimal number of predictors and the best model of that size. Log Poisson regression determined relative risk for good outcome.<\/p>\n<p><strong>Results<\/strong> &#x2014; 202 individuals received a primary TJA (mean age 71.0 years; 79.7% female; 82.7% &gt; 1 troublesome hip\/knee; 65.8% knee replacement). Mean WOMAC summary score improvement was 10.2 points (SD 18.05 = MID 9 points). 53.5% experienced a good outcome. Four predictors were optimal; the best four-variable model included pre-TJA WOMAC, comorbidity, number of joints, and arthritis type (c-statistic 0.80). The probability of a good outcome was greater with worse (higher) pre-TJA WOMAC summary scores (adjusted RR 1.32 per 10-point increase, p&lt;0.0001), fewer troublesome hips\/knees (adjusted RR 0.82 per joint, p=0.002), OA (adjusted RR for RA 0.33, p=0.009), and fewer comorbidities (adjusted RR per condition 0.88, p=0.01).<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; In an OA cohort with high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objective &#x2014; To evaluate patient predictors of &apos;good outcome&apos; following total joint arthroplasty (TJA). Methods &#x2014; A population cohort with hip\/knee arthritis (osteoarthritis, OA; inflammatory arthritis, IA) aged 55+ years was recruited (1996-98; baseline) and assessed annually (demographics, troublesome joints, health status and overall hip\/knee arthritis severity [WOMAC]). Survey data were linked with administrative databases [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[51],"migration-helper-qa-sample-set":[],"class_list":["post-3954","journal_article","type-journal_article","status-publish","hentry","topic-musculoskeletal-diseases-and-disorders"],"acf":{"citation":"Hawker GA, Badley EM, Borkhoff CM, Croxford R, Davis AM, Dunn S, Gignac MA, Jaglal SB, Kreder HJ, Sale JE. <em>Arthritis Rheum<\/em>. 2013; 65(5):1243-52. Epub 2013 Apr 23.","source_url":"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/art.37901\/full","ices_scientist":[1267,1173,1284,1148],"site":[6735,6733],"research_program":[6746],"news_release":[7452],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"E38E63F9-1522-4F98-9CB6-418A2AE14AA6","sitecore_item_name":"Which-patients-are-most-likely-to-benefit-from-total-joint-arthroplasty-","sitecore_field_values":"{\n  \"Title\": \"Which patients are most likely to benefit from total joint arthroplasty?\",\n  \"Short title\": \"Which patients are most likely to\",\n  \"Citation\": \"<p>Hawker GA, Badley EM, Borkhoff CM, Croxford R, Davis AM, Dunn S, Gignac MA, Jaglal SB, Kreder HJ, Sale JE. <em>Arthritis Rheum<\/em>. 2013; 65(5):1243-52. Epub 2013 Apr 23.<\/p>\",\n  \"Abstract\": \"<p><strong>Objective<\/strong> &mdash; To evaluate patient predictors of 'good outcome' following total joint arthroplasty (TJA).<\/p>n<p><strong>Methods<\/strong> &mdash; A population cohort with hip\/knee arthritis (osteoarthritis, OA; inflammatory arthritis, IA) aged 55+ years was recruited (1996-98; baseline) and assessed annually (demographics, troublesome joints, health status and overall hip\/knee arthritis severity [WOMAC]). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as a WOMAC summary score improvement &ge; the Minimal Important Difference (MID = 0.5 SD mean change). Logistic regression and Akaike's Information Criterion determined the optimal number of predictors and the best model of that size. Log Poisson regression determined relative risk for good outcome.<\/p>n<p><strong>Results<\/strong> &mdash; 202 individuals received a primary TJA (mean age 71.0 years; 79.7% female; 82.7% &gt; 1 troublesome hip\/knee; 65.8% knee replacement). Mean WOMAC summary score improvement was 10.2 points (SD 18.05 = MID 9 points). 53.5% experienced a good outcome. Four predictors were optimal; the best four-variable model included pre-TJA WOMAC, comorbidity, number of joints, and arthritis type (c-statistic 0.80). The probability of a good outcome was greater with worse (higher) pre-TJA WOMAC summary scores (adjusted RR 1.32 per 10-point increase, p&lt;0.0001), fewer troublesome hips\/knees (adjusted RR 0.82 per joint, p=0.002), OA (adjusted RR for RA 0.33, p=0.009), and fewer comorbidities (adjusted RR per condition 0.88, p=0.01).<\/p>n<p><strong>Conclusions<\/strong> &mdash; In an OA cohort with high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted.<\/p>n<p><a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/art.37901\/full\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{56451A4A-EDED-4813-9DD5-A60A05094977}\",\n  \"Related Products\": \"<h2>News Release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=640863B0A18143FC969E1B10CC648EF5&amp;_z=z\">Not all patients benefit equally from hip or knee replacement study finds<\/a><\/h3>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"ICES Locations\": \"{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}|{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{4D93CE4E-174C-4555-9897-9FAE06C5C9CE}|{FDF484CC-2616-4FCE-88F8-5CBD62244BF2}|{7EACF790-AB9E-4436-B85A-80BB427D2780}|{F6861DC9-1AF2-4474-B02F-DDF6C62B2911}\",\n  \"Posted Date\": \"20130423T000000\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2013\/January\/Which-patients-are-most-likely-to-benefit-from-total-joint-arthroplasty-"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Which patients are most likely to benefit from total joint arthroplasty?<\/title>\n<meta name=\"description\" content=\"Objective &#x2014; To evaluate patient predictors of &amp;apos;good outcome&amp;apos; following total joint arthroplasty (TJA). 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