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Publication - Professor Ashley Blom

    The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes

    A Study Involving the United Kingdom National Joint Registry Dataset

    Citation

    Edwards, H, Smith, M, Herrett, E, MacGregor, A, Blom, A & Ben-Shlomo, Y, 2018, ‘The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes: A Study Involving the United Kingdom National Joint Registry Dataset’. JBJS Open Access, vol 3.

    Abstract

    Background: Total
    knee replacement (TKR) is a common procedure for the treatment of
    osteoarthritis that provides a substantial reduction of knee pain and
    improved function in most patients. We investigated whether
    sociodemographic factors could explain variations in the benefit
    resulting from TKR.


    Methods: Data
    were collected from 3 sources: the National Joint Registry for England,
    Wales, Northern Ireland, and the Isle of Man; National Health Service
    (NHS) England Patient Reported Outcome Measures; and Hospital Episode
    Statistics. These 3 sources were linked for analysis. Pain and function
    of the knee were measured with use of the Oxford Knee Score (OKS). The
    risk factors of interest were age group, sex, deprivation, and social
    support. The outcomes of interest were sociodemographic differences in
    preoperative scores, 6-month postoperative scores, and change in scores.


    Results: Ninety-one
    thousand nine hundred and thirty-six adults underwent primary TKR for
    the treatment of osteoarthritis in an NHS England unit from 2009 to
    2012. Sixty-six thousand seven hundred and sixty-nine of those patients
    had complete knee score data and were included in the analyses for the
    present study. The preoperative knee scores were worst in female
    patients, younger patients, and patients from deprived areas. At 6
    months postoperatively, the mean knee score had improved by 15.2 points.
    There were small sociodemographic differences in the benefit of
    surgery, with greater area deprivation (−0.71 per quintile of increase
    in deprivation; 95% confidence interval [CI], −0.76 to −0.66; p <
    0.001) and younger age group (−3.51 for ≤50 years compared with 66 to 75
    years; 95% CI, −4.00 to −3.02; p < 0.001) associated with less
    benefit. Cumulatively, sociodemographic factors explained <1% of the
    total variability in improvement.


    Conclusions: Sociodemographic
    factors have a small influence on the benefit resulting from TKR.
    However, as they are associated with the clinical threshold at which the
    procedure is performed, they do affect the eventual outcomes of TKR.


    Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of evidence.


    Full details in the University publications repository