Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2023; 14(12): 853-867
Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.853
Comparison of clinical outcomes between total hip replacement and total knee replacement
Alexander Green, Alex Walsh, Oday Al-Dadah
Alexander Green, Alex Walsh, Oday Al-Dadah, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
Oday Al-Dadah, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4HH, United Kingdom
Author contributions: Green A, Walsh A, and Al-Dadah O contributed to the conception of the study design, data collection and analysis, and all have proofread the manuscript in its final form.
Institutional review board statement: This was a prospective longitudinal observational study which did not require IRB/ethics committee approval but was registered with the local hospital trust.
Informed consent statement: This study was an observational study using existing data from routine clinical care. Therefore, separate consent forms were not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at alexander.green7@nhs.net.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander Green, MBBS, Doctor, Research Fellow, Surgeon, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom. alexander.green7@nhs.net
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: October 9, 2023
Revised: October 18, 2023
Accepted: November 13, 2023
Article in press: November 13, 2023
Published online: December 18, 2023
Processing time: 72 Days and 12.4 Hours
ARTICLE HIGHLIGHTS
Research background

Patient report outcome measures (PROMs) quantitatively assess patient’s symptoms, function and quality of life (QoL). It is known severe osteoarthritis (OA) can be alleviated by joint replacement. To what extent these procedures improve symptoms, function, and QoL can vary depending on the joint, type of procedure, and patient co-factors. Additionally, it is important to maintain a contemporary assessment of the impacts of current surgical practice. The significance of this study is it is the first study of its type to assess the impact of total hip replacements (THR) and total knee replacements (TKR) using a large range of PROMS, in a modern cohort, which also provides sub-analysis on the impact of implant type and obesity.

Research motivation

Previous literature on the impact of THR and TKR is either out-of-date or very narrow in it’s scope. As an orthopedic surgeon, it is important to predict the impact of these procedures, in order to tailor management for each patient. Therefore, knowing the impact of modern arthroplasty on symptoms, function, and QoL should be explored and available in the literature. Additionally, factors such as obesity can significantly deter surgeons from offering surgery to patients due to known peri-operative risks without fully appreciating the long term benefits patients can achieve. It is therefore our motivation to explore if THR and TKR can offer good outcomes to patients and begin to explore which patient, implant and operative factors can lead to the best outcomes or pose particular risks. Future research can use the approach of this study identify which of the factors should be considered when counseling patients with severe OA.

Research objectives

The primary objective of this study was to explore patient reported outcome measures in patients before and after total hip and knee replacement procedures. This was achieved with a sufficiently powered study to detect statistical and clinic significance, and comparison of the two groups was also achieved. Future research can monitor the impact of these procedures as surgical technology continues to improve. Additionally, further research can proceed determine which other factors impact patient outcomes following joint arthroplasty.

Research methods

This study is a pragmatic clinic study of real time clinical practice. The PROMs used in this study are routinely collected in clinical practice and some contribute to data collected by the United Kingdom National Joint Registry. The range of PROMs, although used in a different context, have been utilised in the MD thesis of the senior author. These studies shared similar methodologies to the studies cited. The value of using a range PROMs could be incorporated into national joint registries to allow for research which is highly powered and diverse in its assessment of outcomes.

Research results

This study contributes to the modern literature by demonstrating that hip and knee arthroplasty are equally effective at treating the symptoms of severe OA, and equally successful at improving patient function and QoL. This study reflects more recent clinical practice, more comparable clinical cohorts and a broader range of PROMS than the current literature offers. These results can be built upon to establish which other factors impact patient outcomes following joint arthroplasty.

Research conclusions

This study proposes the theory that hip and knee OA can be equally symptomatic in severity, and limiting in QoL and function to patients. Furthermore, arthoplasty is equally effecting at improving these outcomes, regardless of the method used (cruciate retaining vs posterior stabilized, cemented vs uncemented). This study compares established outcome measures for established surgical procedures. Whilst no new or novel methodology is proposed, a comprehensive assessment has been demonstrated for the first time in the literature.

Research perspectives

Broadly speaking, research should aim to establish which patient, operative and implant factors can be optimised in order to produce the best outcomes, and mitigate risk, for patient undergoing joint arthroplasty for OA.