The value of total hip and knee arthroplasties for patients

Tilbury-Werkhoven, C. (2018)

Doctoral Thesis

Total hip-and total knee arthroplasties (THA/TKA) are effective treatments for end-stage hip/knee osteoarthritis, leading to satisfactory improvement of pain/function in 80-90% of the patients within 12-months after surgery. Overall, knowledge regarding clinical outcomes reflecting the process of recovery in patients undergoing THA/TKA over a prolonged period is scarce.

First, this thesis addressed the successfull feasibility of collecting a comprehensive set of outcomes relevant for the process of recovery.

Second, it was found that the decrease in pain/improvement in function after 1 -year in THA-patients, but not in TKA-patients, was positively associated with more preoperative radiographic severity of OA.

Thirdly, most patients’ preoperative expectations of outcomes of THA/TKA regarding functioning were met, unfortunately more frequently not in TKA-patients.

Finally, 90%/52% of THA/TKA-patients return after surgery after 12-weeks on average. However, despite high return-to-work rates, a considerable proportion of the patients who return-to-work, worked less hours than preoperatively.

Concluding, although overall favourable outcomes were seen, this thesis identified a number of areas for improvement: better identification of subgroups with a likely perceived unsuccessful outcome or recovery process, if not preoperatively then early after surgery. Early identification and subsequent interventions may change the course of recovery of THA/TKA for such patients, leading to added value in this subgroup.

• Total knee Arthroplasty
• Total Hip Arthroplasty
• Osteoarthritis
• Patient Reported Outcomes
• Value-Based health care
• Expectations

• All authors: Tilbury-Werkhoven, C.
• Supervisor: Vliet-Vlieland, T.P.M.; Nelissen, R.G.H.H.
• Committee: Stiggelbout, A.M.; Bulstra, S.K.; Kuijer, P.F.M.; Verdegaal, S.H.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2018-09-05
• ISBN (print): 9789463323758
• Sponsorship: Het Reumafonds, Universiteit Leiden, Nederlandse Orthopaedische Vereniging, SBOH, ChipSoft, Stichting Anna Fonds/NOREF, het Groene Hart Ziekenhuis