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Title: Analysis of patient-reported outcome following hip and knee replacement : interpretation, strengths, limitations and solutions
Author: Gao, Anqi
ISNI:       0000 0004 7960 0323
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2018
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Total knee replacement (TKR) and total hip replacement (THR) are surgical procedures frequently performed to alleviate pain and restore function of the affected joint for people with end-stage osteoarthritis (OA). In order to make a fully informed decision, patients and providers need to acquire a thorough understanding of the short- and long-term success or failure rate of the intervention. In previous studies, various methods have been used to analyse patient-reported outcome (PRO) following TKR and THR, generating a wide range of success rates for the same population. The thesis aimed to address the following three questions: 1. How to define a "successful outcome" following TKR and THR? What are the limitations associated with the current analysis methods? 2. How best to monitor success rate following arthroplasty in the long-term? 3. Is there an alternative way of defining a "successful outcome" that can overcome the limitations in the current methods? If so, what is the potential usage of this novel approach in a clinical context? To assess the success rate of knee replacement and hip replacement operation, the conceptual framework of "sufficient response" was introduced. A "sufficient response" consists of three components -- an instrument used to measure the outcome, a response criterion and its associated cut-off score. Using this framework, the first part of the thesis explored the short-term outcome following TKR and THR, as well as the stability and lability of long-term outcome following TKR. The limitations associated with the current methods for measuring the prevalence of success were also examined. In the second part of this report, the Oxford patient-reported success index (OxPReSI), a novel, alternative method of defining sufficient response was introduced. OxPReSi was constructed upon two anchor questions, which are designed to address patients' self-perceived improvement and satisfaction. Application of OxPReSi divides patients into three categorical outcome groups - high benefit, low benefit and no benefit. The last part of the thesis investigates how OxPReSi can be used pre-operatively during the decision-making period to help patients and clinicians decide on the optimal timing and type of surgery. The results demonstrate that: I) For TKR patients, a pre-operative OKS of above 17 is desirable; once pre-operative score drops below 17, the proportion of ``high benefit'' decreases significantly. The negative effect of low pre-operative OHS is much more minor for the outcome of THR. II) For patients with medial compartmental osteoarthritis, the outcome of partial knee replacement appeared to be superior compared with total knee replacement.
Supervisor: Price, Andrew ; Beard, David Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available