Abstract
Purpose
The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients.
Methods
Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year.
Results
Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.).
Conclusion
Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice.
Level of evidence
Retrospective cohort, Level III.
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Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- EQ-5D:
-
EuroQol 5 dimensions
- FJS-12:
-
Forgotten Joint Score-12
- PRO:
-
Patient-reported outcome
- SD:
-
Standard deviation
- TKA:
-
Total knee arthroplasty
- UK:
-
United Kingdom
- US:
-
United States
- WOMAC:
-
Western Ontario and McMaster Universities Osteoarthritis Index
References
Ackerman IN, Dieppe PA, March LM, Roos EM, Nilsdotter AK, Brown GC et al (2009) Variation in age and physical status prior to total knee and hip replacement surgery: a comparison of centers in Australia and Europe. Arthr Rheum 61:166–173
Baumann F, Weber J, Mahr D, Baumlein M, Kerschbaum M, Muller K et al (2017) Joint awareness in posttraumatic osteoarthritis of the knee: validation of the Forgotten Joint Score in long term condition after tibial plateau fracture. Health Qual Life Outcomes 15:233
Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “Forgotten Joint” as the ultimate goal in joint arthroplasty validation of a new patient-reported outcome measure. J Arthroplasty 27:430–436
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840
Bohm K, Schmid A, Gotze R, Landwehr C, Rothgang H (2013) Five types of OECD healthcare systems: empirical results of a deductive classification. Health Policy 113:258–269
Cao S, Liu N, Han W, Zi Y, Peng F, Li L et al (2017) Simplified Chinese version of the Forgotten Joint Score (FJS) for patients who underwent joint arthroplasty: cross-cultural adaptation and validation. J Orthop Surg Res 12:6
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale
Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Al Khudairy A et al (2015) Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res 24:1775–1784
Cross WW 3rd, Saleh KJ, Wilt TJ, Kane RL (2006) Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res 446:34–39
Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69
Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108
Dowsey MM, Robertsson O, Sundberg M, Lohmander LS, Choong PFM, W-Dahl A (2017) Variations in pain and function before and after total knee arthroplasty: a comparison between Swedish and Australian cohorts. Osteoarthr Cartil 25:885–891
EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208
Franklin PD, Miozzari H, Christofilopoulos P, Hoffmeyer P, Ayers DC, Lubbeke A (2017) Important patient characteristics differ prior to total knee arthroplasty and total hip arthroplasty between Switzerland and the United States. BMC Musculoskelet Disord 18:14
Giesinger JM, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson A et al (2018) Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients’ body mass index. Knee Surg Sports Traumatol Arthrosc 26:3257–3264
Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM (2014) Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthr Cartil 22:184–189
Greiner W, Claes C, Busschbach JJ, von der Schulenburg JM (2005) Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 6:124–130
Hamilton DF, Loth FL, Giesinger JM, Giesinger K, MacDonald DJ, Patton JT et al (2017) Validation of the English language Forgotten Joint Score-12 as an outcome measure for total hip and knee arthroplasty in a British population. Bone Joint J 99-B:218–224
Janssen B, Szende A (2014) Chapter 3 population norms for the EQ-5D. In: Szende A, Janssen B, Cabases J (eds) Self-reported population health: an international perspective based on EQ-5D. Springer, Dordrecht, pp 19–30
Lingard EA, Sledge CB, Learmonth ID, Kinemax Outcomes G (2006) Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am 88:1201–1207
Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA et al (2015) Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 97:1386–1397
Martin JR, Jennings JM, Dennis DA (2017) Morbid obesity and total knee arthroplasty: a growing problem. J Am Acad Orthop Surg 25:188–194
National Joint Registry (2018) National Joint Registry. http://www.njrcentre.org.uk/. Accessed 1 July 2019
No authors listed (2019) The Finnish Arthroplasty Register. 2019. https://thl.fi/far. Accessed 27 Mar 2019
No authors listed (2019) The Swedish Knee Arthroplasty Register. 2019. http://www.myknee.se/en/. Accessed 27 Mar 2019
OECD (2017) Obesity Update 2017. www.oecd.org/health/obesity-update.htm. Accessed 30 Nov 2018
Pabinger C, Lothaller H, Geissler A (2015) Utilization rates of knee-arthroplasty in OECD countries. Osteoarthr Cartil 23:1664–1673
Ponzio DY, Chiu YF, Salvatore A, Lee YY, Lyman S, Windsor RE (2018) An analysis of the influence of physical activity level on total knee arthroplasty expectations, satisfaction, and outcomes: increased revision in active patients at 5–10 years. J Bone Joint Surg Am 100:1539–1548
Rolfson O, Bohm E, Franklin P, Lyman S, Denissen G, Dawson J et al (2016) 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 87(suppl 1):9–23
Rolfson O, Eresian Chenok K, Bohm E, Lubbeke A, Denissen G, Dunn J et al (2016) Patient-reported outcome measures in arthroplasty registries. Acta Orthop 87(Suppl 1):3–8
Siljander MP, McQuivey KS, Fahs AM, Galasso LA, Serdahely KJ, Karadsheh MS (2018) Current trends in patient-reported outcome measures in total joint arthroplasty: a study of 4 major orthopaedic journals. J Arthroplasty 33:3416–3421
Stiftung für Qualitätssicherung in der Implantationsmedizin (2018) Schweizerisches Implantat-Register. http://www.siris-implant.ch. Accessed 30 Nov 2018
The Scottish Arthroplasty Project (2018) The Scottish Arthroplasty Project. https://www.arthro.scot.nhs.uk/. Accessed 30 Nov 2018
The Scottish Government (2018) The Scottish Health Survey 2017 edition. https://www.gov.scot/publications/scottish-health-survey-2017-summary-key-findings/. Accessed 30 Nov 2018
van Reenen M, Oppe M (2015) EQ-5D-3L User Guide. EuroQol Research Foundation, Rotterdam
Acknowledgements
We thank the patients, the data coordinators and those involved in data collection at the respective hospitals for assistance with this project. In particular, we thank Deborah MacDonald (University of Edinburgh) for assistance with the Scottish dataset.
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The authors received no financial support for the research, authorship, and/or publication of this article.
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Two authors are copyright holders of the Forgotten Joint Score-12. Royalties are payable for commercial use of the questionnaire.
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Approval for registry data analysis was obtained from the local ethics committee in Switzerland (EKSG 10/138) and Scotland (16/SS/0026).
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Giesinger, J.M., Giesinger, K., Federico, B. et al. Differences in case mix and outcomes between Swiss and Scottish total knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 28, 1797–1804 (2020). https://doi.org/10.1007/s00167-019-05597-x
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DOI: https://doi.org/10.1007/s00167-019-05597-x