Predicting THA and TKA Patient Outcomes

To what degree can surgeons truly know which patients will benefit from total knee arthroplasty (TKA) or total hip arthroplasty (THA)? New multicenter research says, essentially, not so much.

“Do Surgeon Expectations Predict Clinically Important Improvements in WOMAC Scores After THA and TKA?” appears in the September 2017 edition of Clinical Orthopaedics and Related Research.

Hassan Ghomrawi, Ph.D., M.P.H., associate professor of surgery and pediatrics at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, and co-author on the study told OTW, “Most of the efforts currently are focused on understanding patient expectations and their relationship to outcomes. Yet the decision to undergo elective joint replacement is a shared one that both the patient and the surgeon contribute to. We sought to understand the value of surgeon expectations.”

“This is a prospective cohort study. Orthopedic surgeons participating in this study are experienced high volume surgeons, so their expectations are assumed to be reasonably accurate based on their prior experience, and we used rigorous outcomes (the minimum clinically important difference or MCID) on patient reported outcome measures to determine if patients improved on their WOMAC [Western Ontario and McMaster Universities Arthritis Index] scores. We did not simply rely on statistical difference.”

“Most patients improved in a clinically meaningful way after surgery; 79% of patients who underwent TKA achieved the minimum threshold for improvement in their function and 65% achieved the minimum threshold improvement in their pain relief. Surgeon preoperative expectations were predictive of improvement on WOMAC scores for THA patients; however, surgeons’ expectations were no better than chance in distinguishing between those who did or did not improve after surgery. Thus, our study suggests that the recommendations are not specific to me or my individual characteristics.”

“For THA patients, surgeon expectations can be used as a benchmark that we can compare patient expectations against. Educational interventions can then specifically target patients where discordance is present. For TKA patients, such benchmark is currently not present. Surgeons may need to spend more time with their patients to understand their needs and expectations.”

“Patients look to surgeons to predict the future for them when it comes to their surgeries. Tailoring these recommendations to be patient-centered or fitted to the individual is what we found in our study to be missing, and remains poorly understood. To make a more accurate prediction, surgeons may need to spend more time with their patients to understand their needs and expectations.”