SIT'NWAIT: The Effects of Surgical Wait Time for Knee Arthroplasty Quality of Life in Patients Awaiting Knee Arthroplasty
Study Details
Study Description
Brief Summary
This study prospectively evaluates the effect of surgical wait time on knee function, pain and quality of life in patients waiting for knee arthroplasty (TKA or PKA)
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Osteoarthritis (OA) is a common condition, leading to pain and disability. The knee is the most affected joint, accounting for almost 80 percent of the total prevalence of OA. The pooled global prevalence of knee OA is 22.9% in individuals aged 40 and over. Correspondingly, there are around 654.1 million individuals with knee OA in 2020 worldwide. The number of people affected with symptomatic knee OA is likely to increase because of the aging population and the obesity epidemic.
Pain is the most important symptom in knee OA. It is intermittent, typically weight bearing and progressive over time. Additional symptoms are crepitus, swelling and morning stiffness. The knee is often swollen and has diminished range of motion (ROM). Not only does OA lead to functional disability, but also influences social participation and quality of life.
Knee OA is a progressive disease, which requires continuous management. Treatment consists of conservative as well as invasive treatments, as described in national and international guidelines. First line treatments are patient education, physical therapy, weight loss, different pharmacological treatments and intra-articular steroid injections. More advanced OA may require surgery. knee arthroplasty, (total knee arthroplasty (TKA) or partial knee arthroplasty (PKA)) can provide excellent pain relief, remarkable deformity correction, and satisfactory functional recovery.
Since the beginning of the Covid19 pandemic, surgeons have been asked to only perform essential surgeries in order to preserve healthcare resources. This had led to an increase in patients on the waiting list resulting in unusually high wait times. Despite the decrease in Covid related healthcare consumption, waiting times are yet to return to pre-Covid duration. Currently, time to surgery in our hospital is approximately 7 months as opposed to 2-3 months pre-covid.
Long wait times may be a substantial burden for patients. There have been reports of worsening pain, deterioration in quality of life and increased opioid use and frailty. The effects on pain catastrophizing, fear and anxiety have not yet been studied.
It is important to better understand the effects of long surgical wait times on pre-operative knee function, pain and quality of life as well as to investigate how this effects outcome after surgery.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| patient on the waiting list for knee arthroplasty adult patient on the waiting list for knee arthroplasty |
Other: questionnaires
before surgery, patients are asked to fill out the questionnaires as stated in the outcome measures paragraph
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Outcome Measures
Primary Outcome Measures
- Knee function measured with the Oxford knee score (OKS) [Baseline, before surgery]
This questionnaire consists of 12 items, which are divided into disease-specific and generic questions. Scores can range from 0 - 48, lower scores indicate more functional limitations and pain.
Secondary Outcome Measures
- numeric rating scale for pain (NRS) [baseline, before surgery, 6 and 12 months postoperatively]
This scale consists of 11 numbers from 0-10, where 0 means no pain at all and 10 is the most pain imaginable. The patient should circle the number that best represents the severity of his/her pain experienced over the past week
- Health related quality of life with the euroqol 5 dimensions (EQ-5D-5L) [baseline, before surgery, 6 and 12 months postoperatively]
The EQ-5D is a questionnaire that scores five health dimensions (mobility, self-care, daily activities, pain/discomfort and anxiety/depression). The patient must indicate how he experiences his health status: no problems, slight problems, moderate problems, severe problems, extreme problems.
- Hospital anxiety and depression scale (HADS) [baseline, before surgery, 6 and 12 months postoperatively]
This is a short questionnaire that is easy to use. The scale examines feelings in the past week and consists of an anxiety scale and a depression scale with both 7 items. The higher a patient scores on this questionnaire, the more complaints he/she experiences.
- Pain catastrophizing scale (PCS) [baseline, before surgery, 6 and 12 months postoperatively]
This self-assessment questionnaire consists of 13 statements that contain a number of thoughts and feelings that one may experience having pain. The items are divided into the categories rumination, magnification and helplessness, with each item scored on a 5-point scale. The sum of scores ranges from 0 - 52, with higher scores indicating higher levels of catastrophizing.
Other Outcome Measures
- medical consumption questionnaire (iMCQ) [before surgery]
The iMCQ includes questions related to frequently occurring contacts with health care providers. Reference is made to healthcare consumption due to illness, disability or psychiatric problems, without specifying a particular disease. Healthcare consumption in the preceding 13 weeks is applicable.
- Knee function measured with the Oxford knee score (OKS) [6 and 12 months postoperatively]
This questionnaire consists of 12 items, which are divided into disease-specific and generic questions. Scores can range from 0 - 48, lower scores indicate more functional limitations and pain.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
on the waiting list for partial or total knee arthroplasty
-
written informed consent
Exclusion Criteria:
- none
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Dijklander Hospital | Hoorn | Noord-Holland | Netherlands | 1624NP |
Sponsors and Collaborators
- Dijklander Ziekenhuis
Investigators
- Study Director: Gezina TM Oei, dr, Department of anesthesiology Dijklander Hospital
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Dutch national guideline for non-traumatic knee complaints
- Dutch national guideline for knee arthroplasty
Publications
- Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589. doi: 10.1016/j.joca.2019.06.011. Epub 2019 Jul 3.
- Bedard NA, Elkins JM, Brown TS. Effect of COVID-19 on Hip and Knee Arthroplasty Surgical Volume in the United States. J Arthroplasty. 2020 Jul;35(7S):S45-S48. doi: 10.1016/j.arth.2020.04.060. Epub 2020 Apr 24.
- Bertrix L, Lakhal M, Timour Chah Q, Lang J, Foussat C, Faucon G. [Caudal anesthesia by lidocaine in children. Diffusion in the blood and possible cardiac effects]. Therapie. 1985 Jul-Aug;40(4):225-9. No abstract available. French.
- Bruyere O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier JP, Rannou F, Rizzoli R, Roth R, Uebelhart D, Cooper C, Reginster JY. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019 Dec;49(3):337-350. doi: 10.1016/j.semarthrit.2019.04.008. Epub 2019 Apr 30.
- Bunt CW, Jonas CE, Chang JG. Knee Pain in Adults and Adolescents: The Initial Evaluation. Am Fam Physician. 2018 Nov 1;98(9):576-585.
- Clement ND, Scott CEH, Murray JRD, Howie CR, Deehan DJ; IMPACT-Restart Collaboration. The number of patients "worse than death" while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic. Bone Joint J. 2021 Apr;103-B(4):672-680. doi: 10.1302/0301-620X.103B.BJJ-2021-0104.R1. Epub 2021 Mar 23.
- Clement ND, Wickramasinghe NR, Bayram JM, Hughes K, Oag E, Heinz N, Fraser E, Jefferies JG, Dall GF, Ballantyne A, Jenkins PJ. Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty : a cross-sectional multicentre study. Bone Joint J. 2022 Nov;104-B(11):1215-1224. doi: 10.1302/0301-620X.104B11.BJJ-2022-0470.R2.
- Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020 Nov 26;29-30:100587. doi: 10.1016/j.eclinm.2020.100587. eCollection 2020 Dec.
- Farrow L, Gardner WT, Tang CC, Low R, Forget P, Ashcroft GP. Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study. BMJ Qual Saf. 2023 Aug;32(8):479-484. doi: 10.1136/bmjqs-2021-013450. Epub 2021 Sep 14.
- Henry EB, Barry LE, Hobbins AP, McClure NS, O'Neill C. Estimation of an Instrument-Defined Minimally Important Difference in EQ-5D-5L Index Scores Based on Scoring Algorithms Derived Using the EQ-VT Version 2 Valuation Protocols. Value Health. 2020 Jul;23(7):936-944. doi: 10.1016/j.jval.2020.03.003. Epub 2020 May 14.
- Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019 Apr 27;393(10182):1745-1759. doi: 10.1016/S0140-6736(19)30417-9.
- van Geene AR, Saris DB, Custers RJ. [Pain following primary total knee replacement: causes, diagnosis and treatment]. Ned Tijdschr Geneeskd. 2015;159:A8445. Dutch.
- DOC 23-023