Mega Study Evaluates Joint Patient Outcomes

More than 100 orthopedic surgeons and nearly 7, 000 patients are participating in a study conducted by the University of Massachusetts Medical School to better understand the outcome of total joint replacement surgeries—from the perspective of the patient. The study is in its second year of a four-year project that is funded by a $12 million federal grant. As explained by Brian Boyd, writing in Business Telegram.com, the researchers hope to learn, in fine-grained detail, what practices and circumstances contribute to a successful replacement.

The participating surgeons perform a total of 15, 000 operations or more a year, so the project leaders expect to reach their goal of enrolling 33, 000 patients by the end of the four-year period, indicated Patricia D. Franklin, M.D. a professor of orthopedics, physical rehabilitation, family medicine and community health, who is  the primary investigator. The highest volume and costliest procedure in the Medicare budget is joint replacement, and it is projected to grow exponentially. At the same time, 40% of people who underwent the procedure last year were younger than 65, Franklin said. The medical school’s data so far shows people younger than 65 are going through the procedure for similar reasons as older patients, because of arthritic pain and disability.

“What’s different about this approach is that it is patient-centered, ” said David Ayers, M.D., chairman of orthopedics and physical rehabilitation at the medical school. “In the past, orthopedic registries focused on the implants, not the patients, and replacement surgeries were deemed a success or failure simply depending on whether or not the implant was removed at a later date, ” he said. The approach to creating a registry takes into account whether the quality of life for the patient with the implant is improving, in terms of pain relief and their ability to function.

The medical school staff plans to contact joint recipients at regular intervals—six months, a year, two years and longer—after their surgery to find out how they are managing pain and their physical functioning.

The data gathered should help researchers learn more about which circumstances lead to better outcomes—from patient factors, such as lifestyles and weight, to different surgical approaches and hospital settings. Prior to the publication of the study findings, participating surgeons will have access to the raw data collected on their patients, allowing them to monitor the effectiveness of surgeries that they have performed.

“The analysis will tell us is what is the best practice, what gets the best results after hip or knee replacement, ” Ayers said. “It has enormous potential to be used to help hospitals or insurance companies to look at their patients and determine what their patient outcomes are in comparison to our national sample.”

The medical researchers will publish their findings, along with a summary of the data. In the meantime, participating surgeons have access to the raw data collected on their patients, allowing them to monitor the effectiveness of surgeries that they have performed.

The school’s efforts could provide the health care industry with useful information, Dr. Ayers said.

“It has enormous potential to be used to help hospitals or insurance companies to look at their patients and determine what their patient outcomes are in comparison to our national sample, ” he said.