Health-related quality of life and appropriateness of knee or hip joint replacement. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. Impact of thromboprophylaxis guidelines on clinical outcomes following total hip and total knee replacement. Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. Cement as a risk factor for deep-vein thrombosis. Comparison of cemented TKR, uncemented TKR and cemented THR. Effect of local anaesthetic infiltration on chronic postsurgical pain after total hip and knee replacement: the APEX randomised controlled trials Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study) Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised controlled trials A phase II study of the oral factor Xa inhibitor LY517717 for the prevention of venous thromboembolism after hip or knee replacement. Patient expectations of arthroplasty of the hip and knee.
BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose Objectives To assess how costs and quality of life ( measured by EuroQoL-5 Dimensions ( EQ-5D ) ) before and after total hip replacement ( THR ) and total knee replacement ( TKR ) vary with age , gender and preoperative Oxford hip score ( OHS ) and Oxford knee score ( OKS ) . Design Regression analyses using prospect ively collected data from clinical trials , cohort studies and administrative data bases . Setting UK secondary care . Participants Men and women undergoing primary THR or TKR . The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years . The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years . The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year . Outcome measures EQ-5D-3L quality of life before and after surgery , costs of primary arthroplasty , costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement . Results Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile . The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10 . However , postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44 . In contrast , costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS . For example , costs of hospital readmissions within 12 months after primary THR/TKR were £ 740/£888 for patients at the 5th percentile compared with £ 314/£404 at the 95th percentile of the OHS/OKS distribution . Conclusions Our findings suggest that costs and quality of life associated with total joint replacement vary systematic ally with preoperative symptoms measured by OHS/OKS The aim of this study was to perform a cost-utility analysis of  total hip ( THR ) and knee replacement ( TKR ) .  Arthritis is a disabling condition that leads to long-term deterioration in quality of life . Total joint replacement , despite being one of the greatest advances in medicine of the modern era , has recently come under scrutiny . The National Health Service ( NHS ) has competing dem and s , and re source allocation is challenging in times of economic restraint . Patients who underwent THR ( n = 348 ) or TKR ( n = 323 ) between January and July 2010 in one Scottish region were entered into a prospect i ve arthroplasty data base . A health-utility score was derived from the EuroQol ( EQ-5D ) score pre-operatively and at one year , and was combined with individual life expectancy to derive the quality -adjusted life years ( QALYs ) gained . Two-way analysis of variance was used to compare QALYs gained between procedures , while controlling for baseline differences . The number of QALYs gained was higher after THR than after TKR ( 6.5 vs 4.0 years , p < 0.001 ) . The cost per QALY for THR was £ 1372 compared with £ 2101 for TKR . The predictors of an increase in QALYs gained were poorer health before surgery ( p < 0.001 ) and younger age ( p < 0.001 ) . General health ( EQ-5D VAS ) showed greater improvement after THR than after TKR ( p < 0.001 ) . This study provides up-to- date cost-effectiveness data for total joint replacement . THR and TKR are extremely effective both clinical ly and in terms of cost effectiveness , with costs that compare favourably to those of other medical interventions Primary arthroplasty may be denied to very elderly patients based upon the perceived outcome and risks associated with surgery . This prospect i ve study compared the outcome , complications , and mortality of total hip ( TKR ) and total knee replacement ( TKR )  in a prospect ively selected group of patients aged ≥ 80 years with that of a control group aged between 65 and 74 years . There were 171 and 495 THRs and 185 and 492 TKRs performed in the older and control groups , respectively . No significant difference was observed in the mean improvement of Oxford hip and knee scores between the groups at 12 months ( 0.98 , ( 95 % confidence interval ( CI ) -0.66 to 2.95 ) , p = 0.34 and 1.15 ( 95 % CI -0.65 to 2.94 ) , p = 0.16 , respectively ) . The control group had a significantly ( p = 0.02 and p = 0.04 , respectively ) greater improvement in the physical well being component of their SF-12 score , but the older group was more satisfied with their THR ( p = 0.047 ) . The older group had a longer hospital stay for both THR ( 5.9 versus 9.0 days , p < 0.0001 ) and TKR ( 6.2 versus 8.3 days , p < 0.0001 ) . The rates of post-operative complications and mortality were increased in the older group BACKGROUND The American College of Chest Physicians ( ACCP ) guidelines recommends thromboprophylaxis for total hip replacement ( THR ) and total knee replacement ( TKR ) patients . We examined alignment with ACCP thromboprophylaxis guidelines among THR/TKR patients , and compared symptomatic venous thromboembolism ( VTE ) , bleeding event rates and risk factors for VTE between patients receiving ACCP-recommended thromboprophylaxis ( ' ACCP ' ) and those who did not ( ' non-ACCP ' ) . METHODS This retrospective observational study used a large US health plan cl aims data base that was linked to an inpatient data base containing detailed inpatient medication use and a data base containing date -of-death information . Patients who had THR/TKR surgery between April 01 , 2004 and December 31 , 2006 were included . Comparisons of VTE and bleeding events between ACCP and non-ACCP patients were analyzed using chi-squared tests and multivariate logistic regression . RESULTS Of 3,497 linked patients , 1,395 ( 40 % ) received ACCP recommended thromboprophylaxis . Of the patients who received non-ACCP recommended prophylaxis the majority ( 81 % ) received shorter than the recommended minimum 10 day prophylaxis and 118 ( 5.6 % ) of patients received no prophylaxis . Overall , non-ACCP patients were almost twice as likely to experience an incident DVT ( 3.76 % versus 2.01 % , p=0.003 ) and more than eight times as likely to experience an incident PE ( 1.19 % versus 0.14 % , p=0.001 ) relative to ACCP patients ; there were no statistically significant difference in bleeding rates . Multivariate logistic regression indicated that the odds of a VTE event were significantly lower for ACCP patients ( DVT : OR=0.54 ; p=0.006 ; PE : OR=0.12 ; p=0.004 ) . CONCLUSIONS This study offers a unique perspective on ' real-world ' thromboprophylaxis patterns and associated outcomes in THR and TKR patients in the US . It suggests that only 40 % of THR/TKR patients receive ACCP-recommended thromboprophylaxis and that not receiving ACCP thromboprophylaxis is an independent risk factor for both DVT and PE After total hip ( THR ) or knee replacement ( TKR ) , there is still an appreciable risk of developing deep-vein thrombosis despite prophylaxis with low-molecular-weight heparin ( LMWH ) . In a prospect i ve , r and omised study we examined the efficacy of LMWH in combination with intermittent pneumatic compression in patients undergoing primary unilateral THR or TKR . We administered 40 mg of enoxaparin daily to 131 patients combined with either the use of intermittent pneumatic compression or the wearing of graduated compression stockings . Compression ultrasonography showed no evidence of thrombosis after LMWH and intermittent pneumatic compression . In the group with LMWH and compression stockings the prevalence of thrombosis was 28.6 % ( 40 % after TKR , 14 % after THR ) . This difference was significant ( p < 0.0001 ) . In the early post-operative phase after THR and TKR , combined prophylaxis with LMWH and intermittent pneumatic compression is more effective than LMWH used with graduated compression stockings A total of 110 total knee replacements ( TKRs ) was r and omised to receive either a cemented or an uncemented prosthesis . Postoperative venography at five to seven days was used to compare the prevalence , site and size of deep-vein thrombosis ( DVT ) . We also compared the findings with those of postoperative venography in a group of patients with cemented total hip replacements ( THRs ) . The total prevalence of DVT was significantly greater after uncemented ( 81 % ) than after cemented TKR ( 55 % ) . Both knee groups had a significantly higher prevalence of DVT than in cemented hip replacements ( 32 % ) . We found no difference in the proportion with proximal DVT in the three groups ( 14 % , 15 % and 16 % ) . The median length of the thrombi was significantly greater after cemented ( 26.5 cm ) than after uncemented TKR ( 11 cm ) or after cemented THR ( 7 cm ) . This difference was mainly due to greater lengths of distal rather than proximal thrombi . We conclude that the use of cement may affect the formation of DVT after joint replacement , but does not appear to lead to an increased incidence Abstract Total hip replacement ( THR ) and total knee replacement ( TKR ) are usually effective at relieving pain ; however , 7 % to 23 % of patients experience chronic postsurgical pain . These trials aim ed to investigate the effect of local anaesthetic wound infiltration on pain severity at 12 months after primary THR or TKR for osteoarthritis . Between November 2009 and February 2012 , 322 patients listed for THR and 316 listed for TKR were recruited into a single-centre double-blind r and omised controlled trial . Participants were r and omly assigned ( 1:1 ) to receive local anaesthetic infiltration and st and ard care or st and ard care alone . Participants and outcomes assessors were masked to group allocation . The primary outcome was pain severity on the WOMAC Pain Scale at 12 months after surgery . Analyses were conducted using intention-to-treat and per- protocol approaches . In the hip trial , patients in the intervention group had significantly less pain at 12 months postoperative than patients in the st and ard care group ( differences in means : 4.74 ; 95 % confidence interval [ CI ] : 0.95 - 8.54 ; P = 0.015 ) , although the difference was not clinical ly significant . Post hoc analysis found that patients in the intervention group were more likely to have none to moderate pain than severe pain at 12 months than those in the st and ard care group ( odds ratio : 10.19 ; 95 % CI : 2.10 - 49.55 ; P = 0.004 ) . In the knee trial , there was no strong evidence that the intervention influenced pain severity at 12 months postoperative ( difference in means : 3.83 ; 95 % CI : −0.83 to 8.49 ; P = 0.107 ) . In conclusion , routine use of infiltration could be beneficial in improving long-term pain relief for some patients after THR Background The relationship between leisure time physical activity ( LPA ) and hip and knee OA and subsequent joint replacement has not yet been clearly defined . Some studies have found the risk of knee replacement ( TKR ) to increase with high levels of LPA , while others have found no overall relationship to either TKR or hip replacement ( THR ) . The aim was to investigate the association between LPA and the risk of severe end-stage OA  , defined as THR or TKR due to primary OA , in a large population -based cohort . Methods Participants in the Nord-Trøndelag Health Study ( HUNT ) were followed prospect ively to identify THR and TKR using the Norwegian Arthroplasty Register . Self-reported LPA was classified as inactive , low , moderate or high . The Cox proportional hazards model was used to calculate hazard ratios ( HRs ) according to levels of LPA with adjustments for confounding variables . Analyses were performed by age ( < 45 , 45–59 and ≥60 years ) and sex . Results A total of 66 964 participants ( mean age 46.8 years ( SD 16.3 ) were included in the analyses . We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years ( median ) of follow-up . High LPA was significantly associated with THR for women < 45 years ( HR 1.78 , 95 % CI 1.08–2.94 ) and men between 45–59 years ( HR 1.53 , 95 % CI 1.10–2.13 ) at baseline . A significant trend was found only among women < 45 years at baseline ( p = 0.02 ) . We found that LPA was significantly associated with TKR for women only ( HR 1.45 , 95 % CI 1.03–2.04 ) . No measures of LPA were associated with TKR for men . Conclusion In this population -based study , high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women < 45 years at baseline . For TKR , high LPA was associated with increased risk only in women . In contrast to previous studies , this study shows a possible association between high LPA and the risk of THR Background The Arthroplasty Pain Experience ( APEX ) studies are two r and omised controlled trials in primary total hip ( THR ) and total knee replacement ( TKR ) at a large UK orthopaedics centre . APEX investigated the effect of local anaesthetic wound infiltration ( LAI ) , administered before wound closure , in addition to st and ard analgesia , on pain severity at 12 months . This article reports results of the within-trial economic evaluations . Methods Cost-effectiveness was assessed from the health and social care payer perspective in relation to quality adjusted life years ( QALYs ) and the primary clinical outcome , the WOMAC Pain score at 12-months follow-up . Re source use was collected from hospital records and patient-completed postal question naires , and valued using unit cost estimates from local NHS Trust finance department and national tariffs . Missing data were addressed using multiple imputation chained equations . Costs and outcomes were compared per trial arm and plotted in cost-effectiveness planes . If no arm was dominant ( i.e. , more effective and less expensive than the other ) , incremental cost-effectiveness ratios were estimated . The economic results were bootstrapped incremental net monetary benefit statistics ( INMB ) and cost-effectiveness acceptability curves . One-way deterministic sensitivity analyses explored any method ological uncertainty . Results In both the THR and TKR trials , LAI was the dominant treatment : cost-saving and more effective than st and ard care , in relation to QALYs and WOMAC Pain . Using the £ 20,000 per QALY threshold , in THR , the INMB was £ 1,125 ( 95 % BCI , £ 183 to £ 2,067 ) and the probability of being cost-effective was over 98 % . In TKR , the INMB was £ 264 ( 95 % BCI , −£710 to £ 1,238 ) , but there was only 62 % probability of being cost-effective . When considering an NHS perspective only , LAI was no longer dominant in THR , but still highly cost-effective , with an INMB of £ 961 ( 95 % BCI , £ 50 to £ 1,873 ) . Conclusions Administering LAI is a cost-effective treatment option in THR and TKR surgeries . The evidence , because of larger QALY gain , is stronger for THR . In TKR , there is more uncertainty around the economic result , and smaller QALY gains . Results , however , point to LAI being cheaper than st and ard analgesia , which includes a femoral nerve block . Trial registration IS RCT N96095682 , 29/04/2010 BACKGROUND LY517717 is an oral direct inhibitor of activated factor X that is currently under clinical development . OBJECTIVES The aims of this proof-of-concept study in patients undergoing total knee replacement ( TKR ) or total hip replacement ( THR ) were to determine whether LY517717 can safely reduce the risk of venous thromboembolism ( VTE ) and to identify at least one dose of LY517717 that is non-inferior to enoxaparin . METHODS In a double-blind , parallel-arm , dose-ranging study , patients undergoing TKR or THR were r and omly allocated to receive once-daily oral LY517717 ( 25 , 50 , 75 , 100 , 125 or 150 mg ) , started 6 - 8 h after wound closure , or s.c . enoxaparin , 40 mg , started in the evening before surgery . The primary efficacy endpoint was the composite of deep venous thrombosis ( DVT ) , detected by m and atory bilateral venography performed at the end of the study treatment ( between days 5 and 9 ) , and objective ly confirmed symptomatic DVT and /or pulmonary embolism ( PE ) , occurring during the treatment period . The combination of major and minor bleeding was the primary safety endpoint . RESULTS Five hundred and seven patients received at least one dose of LY517717 or enoxaparin ( safety population ) . Three hundred and ninety-one patients had evaluable bilateral venography or experienced a clinical DVT and /or PE ( primary efficacy population ) . LY517717 treatment result ed in a dose-dependent decrease in the incidence of thromboembolic events ( P = 0.0001 ) . The incidences of VTE with 100 , 125 , and 150 mg of LY517717 were 19 % , 19 % and 16 % , respectively , compared to 21 % with enoxaparin . The efficacies of 100-mg , 125-mg and 150-mg doses of LY517717 were non-inferior to that of enoxaparin according to prespecified criteria . Bleeding events were uncommon in both LY517717 and enoxaparin patients . CONCLUSIONS Doses of 100 , 125 and 150 mg of LY517717 are non-inferior to enoxaparin for the prevention of VTE after TKR or THR , and are associated with similar low rates of bleeding Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of  hip ( THR ) and knee replacement ( TKR ) . The aim of this prospect i ve cohort study was to examine the expectations of patients undergoing THR and TKR  , and to identify differences in expectations , predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures . During the study period , patients who underwent 346 THRs and 323 TKRs  completed an expectation question naire , Oxford score  and  Short-Form 12 ( SF-12 ) score pre-operatively . At one year post-operatively , the Oxford score , SF-12 , patient satisfaction and expectation fulfilment were assessed . Univariable and multivariable analysis were performed . Improvements in mobility and daytime pain were the most important expectations in both groups . Expectation level did not differ between THR and TKR . Poor Oxford score , younger age and male gender significantly predicted high pre-operative expectations ( p < 0.001 ) . The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome . THR better met the expectations identified as important by patients . TKR failed to meet expectations of kneeling , squatting and stair climbing . High fulfilment of expectation in both THR and TKR was significantly predicted by young age , greater improvements in Oxford score and high pre-operative mental health scores . The fulfilment of expectations was highly correlated with satisfaction
Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels , reduce hunger , nausea , and length of stay , and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release .
Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility .
There is limited evidence for nutritional supplementation in THR and TKR pathways ; however , the low risk profile and potential benefits to adjunctive treatment methods , such as exercise programs , suggest nutritional supplements may have a role .
Optimizing nutritional status pre-operatively may help manage the surgical stress response , with a particular benefit for undernourished , frail , or elderly individuals
Nutritional supplements can influence outcomes for individuals undergoing major surgery , particularly in older persons whose functional reserve is limited .
Accelerating recovery from total hip replacement ( THR ) and total knee replacement ( TKR ) may offer significant benefits .
Therefore , we explored the role of nutritional supplements in improving recovery following THR and TKR .