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| Towards better surgical outcomes through improved decision making about appropriateness for total knee arthroplasty in patients with knee osteoarthritis | |
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| Investigator (PI): | Hawker, Gillian A; Marshall, Deborah A |
| Performing Organization (PO): |
(Current): Women's College Hospital, Women's College Research Institute / (416) 351-3732 |
| Supporting Agency (SA): | Canadian Institutes of Health Research (CIHR) |
| Initial Year: | 2014 |
| Final Year: | 2019 |
| Record Source/Award ID: | CIHR/133516 |
| Funding: | Total Award Amount: $764,384 2015 Award Amount: $185,922 |
| Award Type: | Grant |
| Abstract: | Knee replacement (KR) reduces pain and disability in Canadians with knee arthritis. The rates of KR are increasing partly due to obesity, a risk factor for knee arthritis, strategies to improve access, and technical advances, with the greatest rise in those <60 years old. Younger age at KR increases risk for needing another KR (revision); revision KR is less successful and more costly. The amount of knee pain and disability that patients report at KR is decreasing, suggesting overuse of KR. Clarity about the indications for KR is needed. While, on average, KR works, 15-30% get little symptom relief or are dissatisfied with the results. Better decision making about appropriateness for KR may improve outcomes. We conducted focus groups and interviews in patients and orthopedic surgeons to get their opinions on what is important in assessing patients' appropriateness for KR. Four criteria were identified: demonstrated KR need; ready, willing, and able to undergo surgery; realistic expectations; and benefit greater than risk. Participants agreed that surgeons did not consistently discuss/assess these criteria and increased transparency about patient selection for KR would be helpful. The proposed study will evaluate how well these criteria, measured at consultation and KR with existing questionnaires, can identify patients who will/will not have a successful KR. We will recruit knee arthritis patients aged 40+ years seen in consultation for KR at 1 of 3 Alberta hip/knee clinics. In eligible, consenting individuals, we will assess KR appropriateness at consult and, in those who have KR, pre-KR. Pre-KR, the surgeon will indicate if the patient's KR expectations are realistic. At 6 and 12 months post-KR, we will assess outcomes (pain, function, expectations met, satisfaction) by interview. Alberta health data will be used to identify KR complications to 2 years. Our findings will be used to develop a tool to support patient-surgeon decision making about appropriateness for KR. |
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| Country: | Canada |
| State: | Ontario |
| Zip Code: | M5S 1B2 |
| UI: | 20162138 |
| Project Status: | Completed |