Optimization of care in orthopaedics and neurosurgery

Abstract

This thesis aimed to contribute to the optimal use of non-surgical treatment and timing of surgery among hip and knee OA and sciatica patients in two different ways. First, if guidelines are specific on non-surgical and (timing of) surgical treatment, the focus was on implementation strategies to improve guideline uptake in hip and knee OA and sciatica care. Across the different studies carried out in this thesis, knowledge, attitude of health care providers and organization of care seem to be relevant for any implementation of evidence based guideline recommendations in a multidisciplinary setting. Future implementation studies can start focusing on these topics.

However, if guidelines are not available or not specific on e.g. optimal timing of total hip or knee arthroplasty (THA/TKA), additional evidence is needed. Therefore, the second part of this thesis focused on studying criteria and determinants to reach the best possible outcomes after THA and TKA, as information in the literature is lacking on optimal timing of surgery. Pooling multiple cohort studies in the Netherlands showed that preoperative status is the most important variable for outcome after both THA and TKA, i.e. patients with better preoperative quality of life, functioning and less pain had better postoperative outcomes.