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| 2. |
- Nebergall, A. K., et al.
(författare)
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Stable Fixation of a Cementless, Proximally Coated, Double Wedged, Double Tapered Femoral Stem in Total Hip Arthroplasty: A 5-Year Radiostereometric Analysis
- 2016
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Ingår i: Journal of Arthroplasty. - : Elsevier BV. - 0883-5403. ; 31:6, s. 1267-1274
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Tidskriftsartikel (refereegranskat)abstract
- Background: The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). Methods: Forty-seven patients (51 hips) agreed to participate in this prospective RSA study. All patients received a Taperloc stem. Tantalum beads were inserted into the femoral bone surrounding the stem to measure migration using RSA. RSA films, plain radiograph, and PROM follow-up were obtained immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. Results: The median (interquartile range) subsidence was 0.03 mm (-0.23 to 0.06) at 5 years, with no significant differences over time. Four outlier stems had >1.5 mm of subsidence by 1 year. No stem showed radiolucencies in more than 3 zones during the 5 years. All PROMs remained favorable at 5 years, suggesting an excellent outcome. There were no stems revised for mechanical loosening; 1 stem was revised for an infection. Conclusion: After initial settling, the cementless tapered femoral stems in our series were stable. The 4 outlier stems with >1.5 mm of subsidence by 1 year remain stable at 5 years. RSA was the most sensitive method of detection for stems at greater risk for potential future failure. This report adds contributions to the positive results associated with this type of fixation. The results at 5 years showed excellent midterm survivorship in this cohort with a cementless tapered femoral component. (C) 2015 Elsevier Inc. All rights reserved.
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| 4. |
- Gordon, Max, et al.
(författare)
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Women in Charnley class C fail to improve in mobility to a higher degree after total hip replacement.
- 2014
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Ingår i: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:4, s. 335-41
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Tidskriftsartikel (refereegranskat)abstract
- The Charnley comorbidity classification organizes patients into 3 classes: (A) 1 hip involved, (B) 2 hips involved, and (C) other severe comorbidities. Although this simple classification is a known predictor of health-related quality of life (HRQoL) after total hip replacement (THR), interactions between Charnley class, sex, and age have not been investigated and there is uncertainty regarding whether A and B should be grouped together.
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| 5. |
- Greene, Meridith E, et al.
(författare)
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Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register.
- 2014
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Ingår i: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 472:6, s. 1868-76
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Tidskriftsartikel (refereegranskat)abstract
- Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.
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| 6. |
- Greene, Meridith E, et al.
(författare)
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Improved statistical analysis of pre- and post-treatment patient-reported outcome measures (PROMs): the applicability of piecewise linear regression splines
- 2015
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Ingår i: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. - : Springer Science and Business Media LLC. - 1573-2649. ; 24:3, s. 567-573
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Tidskriftsartikel (refereegranskat)abstract
- Patient-reported health-related quality-of-life (HRQoL) measures such as the EuroQol 5 dimension (EQ-5D) index are commonplace when assessing healthcare providers or efficiency of medical techniques. HRQoL measures are generally bounded, and the magnitude of possible improvement depends on the pre-treatment HRQoL value. This paper aimed to assess and illustrated the possibility of modelling the relationship between pre- and post-treatment HRQoL measures with piecewise linear splines.
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| 7. |
- Greene, Meridith E, et al.
(författare)
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Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery?
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87:5, s. 444-451
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Patients with anxiety and/or depression tend to report less pain reduction and less satisfaction with surgical treatment. We hypothesized that the use of antidepressants would be correlated to patient-reported outcomes (PROs) 1 year after total hip replacement (THR), where increased dosage or discontinuation would be associated with worse outcomes. Patients and methods - THR cases with pre- and postoperative patient-reported outcome measures (PROMs) were selected from the Swedish Hip Arthroplasty Register (n = 9,092; women: n = 5,106). The PROMs were EQ-5D, visual analog scale (VAS) for pain, Charnley class, and VAS for satisfaction after surgery. These cases were merged with a national database of prescription purchases to determine the prevalence of antidepressant purchases. Regression analyses were performed where PROs were dependent variables and sex, age, Charnley class, preoperative pain, preoperative health-related quality of life (HRQoL), patient-reported anxiety/depression, and antidepressant use were independent variables. Results - Antidepressants were used by 10% of the cases (n = 943). Patients using antidepressants had poorer HRQoL and higher levels of pain before and after surgery and they experienced less satisfaction. Preoperative antidepressant use was independently associated with PROs 1 year after THR regardless of patient-reported anxiety/depression. Interpretation - Antidepressant usage before surgery was associated with reduced PROs after THR. Cases at risk of poorer outcomes may be identified through review of the patient's medical record. Clinicians are encouraged to screen for antidepressant use preoperatively, because their use may be associated with PROs after THR.
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| 8. |
- Greene, Meridith E, et al.
(författare)
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Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty
- 2015
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Ingår i: Clinical orthopaedics and related research. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1132 .- 0009-921X. ; 473:11, s. 3370-3379
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Tidskriftsartikel (refereegranskat)abstract
- Comorbidities influence surgical outcomes and therefore need to be included in risk adjustment when predicting patient-reported outcomes. However, there is no consensus on how best to use the available data about comorbidities in registry-based predictive models.
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| 9. |
- Greene, Meridith E, et al.
(författare)
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The EQ-5D-5L Improves on the EQ-5D-3L for Health-related Quality-of-life Assessment in Patients Undergoing Total Hip Arthroplasty
- 2015
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Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X .- 1528-1132. ; 473:11, s. 3383-3390
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Tidskriftsartikel (refereegranskat)abstract
- The EQ-5D is a generic health survey that can be used to compare improvement across different interventions, measure changes in health-related quality of life over time, or to explore cost-effectiveness among treatments, hospitals, or providers. The original EQ-5D survey has three response options for each of five health dimensions; however, with so few response options, ceiling and floor effects are problematic in some populations. A new version, called the EQ-5D-5L, was developed, which gives respondents five answer options (the "5L" refers to five response levels, which is in contrast to the original survey's three levels). However, the validity of this version has not, to our knowledge, been evaluated in patients undergoing total hip arthroplasty (THA).
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| 10. |
- Greene, Meridith E
(författare)
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Who should have total hip replacement? Use of patient-reported outcome measures in identifying the indications for and assessment of total hip replacement
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Total hip replacement (THR) is a successful treatment for end-stage hip osteoarthritis (OA). Patients commonly seek this treatment to improve physical function, diminish pain, and ultimately to increase health-related quality of life (HRQoL). In recent years, patients have been asked to self-assess these areas using patient-reported outcomes measures (PROMs) both before and after treatment. Combining PROMS with national registers allows identification of factors that may influence how a patient will do after treatment. Detection of factors influencing poor outcomes after elective THR is important for understanding how to improve the effectiveness of this treatment. Objectives: These works aimed to identify patient factors that contribute to better or worse patient-reported outcomes (PROs) after THR and to identify the most influential patient factors on surgical recommendation. In doing so, new PROMs were explored, as were various methodologies for investigating these types of data. Patients and Methods: The first four papers utilized patients from the national Swedish Hip Arthroplasty Register (SHAR) while the last two papers include patients from the Harris Joint Registry (HJR). The influence of comorbid conditions, education, marital status, mental health, OA severity, and preoperative health states on surgical recommendations and patient-reported HRQoL, pain, and satisfaction after THR was explored. A new version of the EQ-5D survey was investigated and how best to treat the relationship between the preoperative and postoperative EQ-5D index scores. Results: On average, PROs improved after THR. Those who started with worse scores tended to improve similar amounts to those with better preoperative scores; however, due to their starting point, they did not achieve scores that were as high after surgery. Individuals with greater musculoskeletal comorbidities, with low or medium levels of education, and a history of preoperative antidepressant use, were identified as being patients who began and ended with worse PROs. The severity of a patient’s OA had the greatest influence on THR recommendations. The new version of the EQ-5D survey appeared to better measure HRQoL in both preoperative and postoperative patients. Less ceiling effects were seen and substantial utilization of the new answer options occurred particularly before THR surgery. Conclusions: Patients at risk for poor outcomes can be identified through preoperative reporting of musculoskeletal comorbidities and their medical record. Clinicians are not discouraged from treating these patients, but rather are encouraged to discuss individual risk factors to aid in the decision-making process for the patient.
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| 11. |
- Nemes, Szilard, 1977, et al.
(författare)
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Summary statistics for patient-reported outcome measures: the improvement ratio
- 2015
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Ingår i: European journal for person centered healthcare. - 2052-5656. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objective: Patient-reported outcomes measures (PROMs) can facilitate objective comparisons of alternative treatments and can aid clinicians, researchers, decision-makers and members of the general public in gauging different healthcare providers’ performance. However, this assumes an easy to use and understand summary measure. Methods: Using PROMs (EQ-5D index, EQ VAS and VAS Pain) from 1799 patients in 7 Swedish hospitals with at least 200 hip arthroplasty surgeries in 2009, we illustrated the possibility of summarizing pre- and post-treatment PROM values with the help of a simple index. This index expressed the attained improvement as a percentage of the total possible improvement. Change score, Cohen’s effect size and Standardized Response Means served as alternative measures. Results: The Improvement Ratio index proved capable of offering a vivid and easy to understand summary of healthcare providers’ performance. The alternative measures indicated similar patterns as the Improvement Index. The routines of statistical inference made possible null-hypothesis testing of the improvement in different groups or testing for trends. Conclusions: This simple improvement index gives an easy to understand summary measure that appeals not only to researchers, but also to laymen for consulting healthcare provider comparisons or countrywide white papers. We recommend using the Improvement Ratio index to summarize the PROMs outcome of elective surgeries.
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