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PROMs in total knee replacement: analysis of negative outcomes
F Begum1, A Panagiotidou1, C Park1
1Northwick Park Hospital, London North West Healthcare NHS Trust, UK.
Annals of the Royal College of Surgeons of England
|August 25, 2020
Summary
The Oxford Knee Score (OKS) may not accurately reflect patient recovery after knee replacement, as negative initial outcomes improved significantly over time. Revalidation of this patient-reported outcome measure is recommended for reliable healthcare data.
Area of Science:
- Orthopedic surgery outcomes assessment
- Patient-reported outcome measures (PROMs) validation
Background:
- NHS England utilizes the Oxford Knee Score (OKS) for evaluating total knee replacement outcomes.
- Policy decisions regarding healthcare funding and resource allocation rely on OKS data.
- This study investigates OKS in patients experiencing negative outcomes post-total knee replacement.
Purpose of the Study:
- To qualitatively and quantitatively analyze the Oxford Knee Score (OKS) in patients with negative outcomes after total knee replacement.
- To assess the reliability and validity of the OKS in reflecting true patient 'health gains' over time.
- To identify potential limitations in current PROMs for post-surgical recovery assessment.
Main Methods:
- Retrospective and prospective review of 14 patients with worsened OKS between April 2017-March 2018.
- Structured telephone interviews and repeat OKS administration conducted 18-29 months post-operation.
- Analysis of OKS changes from preoperative, 6-month, and 18-29 month postoperative periods.
Main Results:
- 10% of patients (19/189) experienced a worsened OKS post-total knee replacement.
- Average OKS decreased by 20% at 6 months post-operation but increased by 83.5% by 18-29 months.
- Four patients required clarification for ambiguous questions (4, 6, 10) within the OKS.
Conclusions:
- The Oxford Knee Score (OKS) may underestimate 'health gains' due to its timing and potential ambiguity.
- Significant improvement in OKS was observed in patients initially reporting negative outcomes.
- Revalidation of the OKS on current patient populations and further prospective studies are recommended.
