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      Spinal fusion achieves similar two-year improvement in HRQoL as total hip and total knee replacement. A prospective, multicentric and observational study


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          Introduction: Total hip and knee arthroplasty (THA/TKA) are surgical procedures with proven benefits. Although the literature reports outcomes of fusion of the lumbar spine comparable to those of THA/TKA in general health-related quality-of-life (HRQoL) questionnaires, functional assessment is nevertheless needed for these results to be of use in clinical practice and management. Aim of our study was to prove that lumbar spinal fusion has similar if not better outcomes than THA/TKA using intervention-specific HRQoL questionnaires and functional assessment questionnaires.

          Materials and methods: Observational, ambispective, multicentre study of three cohorts undergoing lumbar spinal fusion ( n = 115), THA ( n = 119) and TKA ( n = 253). Patients were evaluated using the Short-Form-12 (SF-12), Harris–Hip-Score, Hospital for Special Surgery Scale (HSS) and Oswestry Low Back Pain Disability questionnaires. A minimum follow-up of two years was conducted.

          Results: The SF-12 showed significant improvement in all groups. The SF-12 physical component summary score indicated a more severe pre-operative status ( p =  0.031) in the THA cohort. The mental component summary score indicated a less severe pre-operative status in the TKA cohort ( p =  0.008) and greater post-operative improvement in the TKA and THA cohorts across follow-up (six months p =  0.021; one year p =  0.012; two years p =  0.042). Functional assessment indicated greater pre-operative disability in the THA group. At two years of follow-up, functional improvement according to the Harris, HSS and Oswestry questionnaires were 152.01%, 50.07% and 41.14% respectively.

          Conclusions: This study demonstrates that lumbar spinal fusion and total knee and hip arthroplasty are comparable in terms of functional improvement when thoroughly studied with health, quality-of-life and functional assessment questionnaires.

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          Most cited references41

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          Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature.

          Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes in order to optimize the allocation of resources. The objective of this study was to review the literature regarding the outcomes of total hip and knee arthroplasties as evaluated by health-related quality-of-life instruments. The Medline and EMBASE medical literature databases were searched, from January 1980 to June 2003, to identify relevant studies. Studies were eligible for review if they met the following criteria: (1). the language was English or French, (2). at least one well-validated and self-reported health-related quality of life instrument was used, and (3). a prospective cohort study design was used. Of the seventy-four studies selected for the review, thirty-two investigated both total hip and total knee arthroplasties, twenty-six focused on total hip arthroplasty, and sixteen focused on total knee arthroplasty exclusively. The most common diagnosis was osteoarthritis. The duration of follow-up ranged from seven days to seven years, with the majority of studies describing results at six to twelve months. The Short Form-36 and the Western Ontario and McMaster University Osteoarthritis Index, the most frequently used instruments, were employed in forty and twenty-eight studies, respectively. Seventeen studies used a utility index. Overall, total hip and total knee arthroplasties were found to be quite effective in terms of improvement in health-related quality-of-life dimensions, with the occasional exception of the social dimension. Age was not found to be an obstacle to effective surgery, and men seemed to benefit more from the intervention than did women. When improvement was found to be modest, the role of comorbidities was highlighted. Total hip arthroplasty appears to return patients to function to a greater extent than do knee procedures, and primary surgery offers greater improvement than does revision. Patients who had poorer preoperative health-related quality of life were more likely to experience greater improvement. Health-related quality-of-life data are valuable, can provide relevant health-status information to health professionals, and should be used as a rationale for the implementation of the most adequate standard of care. Additional knowledge and scientific dissemination of surgery outcomes should help to ensure better management of patients undergoing total hip or total knee arthroplasty and to optimize the use of these procedures.
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            Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

            The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time. The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender. Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time. The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty. The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.
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              Outcome measures for low back pain research. A proposal for standardized use.

              An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain. To promote more standardization of outcome measurement in clinical trials and other types of outcomes research, including meta-analyses, cost-effectiveness analyses, and multicenter studies. Better standardization of outcome measurement would facilitate comparison of results among studies, and more complete reporting of relevant outcomes. Because back pain is rarely fatal or completely cured, outcome assessment is complex and involves multiple dimensions. These include symptoms, function, general well-being, work disability, and satisfaction with care. The panel considered several factors in recommending a standard battery of outcome measures. These included reliability, validity, responsiveness, and practicality of the measures. In addition, compatibility with widely used and promoted batteries such, as the American Academy of Orthopaedic Surgeons Lumbar Cluster were considered to minimize the need for changes when these instruments are used. First, a six-item set was proposed, which is sufficiently brief that it could be used in routine care settings for quality improvement and for research purposes. An expanded outcome set, which would provide more precise measurement for research purposes, includes measures of severity and frequency of symptoms, either the Roland or the Oswestry Disability Scale, either the SF-12 or the EuroQol measure of general health status, a question about satisfaction with symptoms, three types of "disability days," and an optional single item on overall satisfaction with medical care. Standardized measurement of outcomes would facilitate scientific advances in clinical care. A short, 6-item questionnaire and a somewhat expanded, more precise battery of questionnaires can be recommended. Although many considerations support such recommendations, more data on responsiveness and the minimally important change in scores are needed for most of the instruments.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                30 July 2019
                : 5
                : ( publisher-idID: sicotj/2019/01 )
                : 26
                [1 ] Department of Spine, Fundación Jiménez Díaz University Hospital Av. de los Reyes Católicos, 2 28040 Madrid Spain
                [2 ] Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital Carretera de Alpedrete a Moralzarzal M-608 Km 41 28400 Madrid Spain
                [3 ] Division of Orthopedics and Trauma Surgery, University of Perugia, “S. Maria della Misericordia Hospital”, S. Andrea delle Fratte Piazzale Giorgio Menghini, 1 06129 Perugia Italy
                [4 ] León University Health Care Centre Campus de Vegazana, s/n 24071 León Spain
                [5 ] Research Support Unit, San Agustín Hospital Camino de Heros, 6 33401 Avilés Spain
                [6 ] Catalonian General Hospital Carrer Pedro i Pons, 1, Sant Cugat del Vallés 08195 Barcelona Spain
                [7 ] Gómez Ulla Central Armed Forces Hospital Glorieta Ejército, 1 28047 Madrid Spain
                [8 ] Department of Orthopedics and Traumatology, Vito Fazzi Hospital Block A – V Floor, Piazzetta Muratore 73100 Lecce Italy
                Author notes
                [* ]Corresponding author: drlordmec@ 123456gmail.com
                Author information
                sicotj190019 10.1051/sicotj/2019027
                © The Authors, published by EDP Sciences, 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 26 February 2019
                : 16 July 2019
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 40, Pages: 8
                Original Article

                hip arthroplasty,knee arthroplasty,spinal surgery,quality of life,functional assessment


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