New online tool predicts individual risks and benefits of joint replacements

An innovative online tool devised by researchers from the University of Sheffield will give patients unique personalised information about the risks and benefits of having a joint replacement for the first time. University of Sheffield

Amy Huxtable, University of Sheffield 7 June 2019

A total of over 220,000 hip and knee replacement procedures are performed in the UK each year. At the moment, patients are given very general information about the procedure either from their GP, consultant or by searching on the internet.

The easy-to-use Patient Decision Aid For Joint Replacement generates an individualised set of results for patients based on a variety of factors including: how long the implant will last, predicted pain and function levels before and after surgery and the associated risks such as death rate.

The tool gives specifically tailored information to individual patients about the risks and benefits of having a joint replacement both now or in the future

  • The easy-to-use survey generates a unique set of results for a variety of factors including how long the implant may last, a pain and function score before and after surgery and risk of death
  • The tool can be used by patients in their own home or by GPs during appointments
  • It is hoped the tool will both improve the success rate of joint replacements and prevent unnecessary surgery, saving the NHS money

Information from more than one million patients who have already undergone hip and knee replacements, recorded by the National Joint Registry, was used to create the intuitive tool which it is hoped will both improve the success rate of joint replacements and prevent unnecessary surgery, saving the NHS money.

Professor Mark Wilkinson from the University of Sheffield’s Department of Oncology and Metabolism led the creation of the new tool, which can be used by patients in their own homes or by GPs during patient appointments.

He said: “At the moment it is impossible for GPs and consultants to give each individual patient tailored information specific to them and their lifestyle. By using data from more than one million patients who have already undergone surgery, and information from individuals about their lifestyle and how joint pain currently impacts on their life, the tool is able to provide the risks and benefits in more detail than ever before.

“Everyone has slightly different expectations about what they hope their treatment will provide for them and hopefully the risk calculator will answer their questions.

“We hope the tool will help patients make better decisions about undergoing joint replacements based on their own personal circumstances. Patients also have the option to see how their results would change if, for instance, they lost weight or if they waited a couple of years before surgery.”

Marian Whitney, 85, from Sheffield went to the GP two years ago after suffering from hip pain which was affecting her active lifestyle. She was referred to a consultant earlier this year and is currently waiting for an appointment to discuss a potential replacement.

She said: “It was really interesting to find out all of the specific information about myself and what the outcomes are likely to be if I were to have the operation, such as how much it would improve my life and what the chances were of dying from the operation – it was all very interesting and I think the whole thing is very well thought out.

“I have a very active social life and enjoy a number of hobbies such as croquet, so I have always been concerned about the length of time it would take me to recover from a hip replacement.”

She added: “Using the tool has given me a whole host of information which I can now talk through with the consultant at my forthcoming appointment. It has been very helpful and I am sure it will be useful for lots of people in a similar position to myself.”

Martha Holmes, 69, from Sheffield, underwent her first hip replacement four years ago and a replacement of the other hip nine months ago. She said the tool would have been very useful when thinking about the decision to have surgery.

She said: “I always try to encourage anyone who is thinking about a replacement to go for it, and go for it as soon as possible. I’m a big walker and love going out hiking and it got to the stage where I could barely walk up the street. For me, not being able to walk really got me down.

“When you are deciding whether or not to have a hip replacement you have to think about what things you love to do that you can’t do now and then think about getting that back again.”

The tool was built by the University of Sheffield in collaboration with the University of Bristol, with support from the National Joint Registry and Versus Arthritis.

The data for the tool was provided by the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man which collects information on hip, knee, ankle, elbow and shoulder replacement surgery and monitors the performance of joint replacement implants. The organisation started collecting data in April 2003 and submission for NHS organisations has been mandatory since April 2011, as part of a continuous drive to improve the quality of outcomes of joint replacement surgery and support and enable related research.

The Joint Replacement Risk Calculator  

Source University of Sheffield via Medical Xpress

 

  Further reading
Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales, Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Foguet P, Porter M, Blom AW; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Lancet Infect Dis. 2019 Jun;19(6):589-600. doi: 10.1016/S1473-3099(18)30755-2. Epub 2019 Apr 17. Full text

The employment of Patient-Reported Outcome Measures to communicate the likely benefits of surgery, Briffa N. Patient Relat Outcome Meas. 2018 Aug 16;9:263-266. doi: 10.2147/PROM.S132746. eCollection 2018. Review. Full text

Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study, Bunzli S, Nelson E, Scott A, French S, Choong P, Dowsey M. BMJ Open. 2017 Nov 12;7(11):e018614. doi: 10.1136/bmjopen-2017-018614. Full text

Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis, Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD; INFORM Team. PLoS One. 2016 Mar 3;11(3):e0150866. doi: 10.1371/journal.pone.0150866. eCollection 2016. Review. Full text

How outcome prediction could affect patient decision making in knee replacements: a qualitative study, Barlow T, Scott P, Griffin D, Realpe A. BMC Musculoskelet Disord. 2016 Jul 22;17:304. doi: 10.1186/s12891-016-1165-x. Full text

Patient decision aids in knee replacement surgery, Jayadev C, Khan T, Coulter A, Beard DJ, Price AJ. Knee. 2012 Dec;19(6):746-50. doi: 10.1016/j.knee.2012.02.001. Epub 2012 Mar 2. Review.

Also see
Risk factors identified for patients undergoing knee replacements in University of Bristol
Surgeon to develop tool to predict knee and hip operation risks in Versus Arthritis
National Joint Registry UK

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