Determining the Effect of Deprivation on Quality of Life after Total and Unicompartmental Knee Arthroplasty

Abstract

Determining the effect of deprivation on quality of life after total and unicompartmental knee arthroplasty Quality of life (QoL) following joint replacement is now a national priority, with every patient being assessed using the Oxford Knee Score. The current literature is conflicted as to whether deprivation has any effect on outcome after knee surgery. The type of surgery is another variable that may determine outcome. We set out to investigate which of these factors was a more powerful predictor of outcome. A prospective trial began where, 68 patients were telephoned, (30 TKA’s and 38 UKA’s). Each were asked a series of questions comprising the Oxford Knee Score (post operation), Imperial Knee Score (post operation), EuroQol-5D (pre and post operation) and individual deprivation questions. This was compared with the deprivation status using Townsend scores. A comparison of total and unicompartmental outcomes were also analysed including cost-effectiveness. No correlation was found between outcome and Townsend scores (p < 0.05). Age was seen to be a significant indicator of pre surgical QoL. However, a large and significant difference was found between UKA and TKA when using the EQ-5D (p < 0.05) and the Imperial Knee Score (p < 0.09). This was not reflected in the Oxford Knee Score. UKA’s were also found to be more cost-effective than TKA’s. Deprivation has no major effect on the outcome of knee surgery in London. A clear difference in efficacy exists between TKA’s and UKA’s. Sensitivity of scores needs to be addressed.

Share and Cite:

Malik, A. , Ahmad, M. and Cobb, J. (2015) Determining the Effect of Deprivation on Quality of Life after Total and Unicompartmental Knee Arthroplasty. Open Journal of Orthopedics, 5, 140-150. doi: 10.4236/ojo.2015.56019.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Department of Health (2000) The NHS Plan. HMSO, London.
[2] Office National Statistocs (2005) Life Tables.
http://www.statistics.gov.uk/STATBASE/ssdataset
[3] Murray, J., Birdsall, D.P., Cleary, R., Deehan, D.J. and Sher, J.L. (2005) Deprivation and Outcome after Knee Surgery. Journal of Bone and Joint Surgery, The Knee, 13, 98-101.
http://dx.doi.org/10.1016/j.knee.2005.11.002
[4] Yong, P.F.K., Milner, P.C., Payne, J.N., Lewis, P.A. and Jennison, C. (2004) Inequalities in Access to Knee Joint Replacements for People in Need. Annals of the Rheumatic Diseases, 63, 1483-1489.
http://dx.doi.org/10.1136/ard.2003.013938
[5] Newman, J.H., Ackroyd, C.E. and Shah, N.A. (1998) Unicompartmentalor Total Knee Replacement? Five-Year Results of a Prospective, Randomised Trial of 102 Osteoarthritic Knees with Unicompartmental Arthritis. Journal of Bone & Joint Surgery, 91-B, 52-57.
[6] Laurencin, C.T., Zelicof, S.B., Scott, R.D. and Ewald, F.C. (1996) Unicompartmental versus Total Knee Arthroplasty in the Same Patient. Clinical Orthopaedics & Related Research, 273, 151-156.
[7] Rasanen, P., et al. (2007) Effectiveness of Hip or Knee Replacement Surgery in Terms of Quality-Adjusted Life Years and Costs. Acta Orthopaedica, 78, 108-115.
http://dx.doi.org/10.1080/17453670610013501
[8] National Joint Registry (2006) Knee Replacement Statistics.
www.njrcentre.org.uk
[9] Ethgen, O., et al. (2004) Health-Related Quality of Life in Total Hip and Total Kne Arthroplasty. A Qualitative and Systematic Review of the Literature. Journal of Bone and Joint Surgery, 86, 963-974.
[10] Farquhar, M. (1995) Definitions of Quality of Life: A Taxonomy. Journal of Advanced Nursing, 22, 502-508.
http://dx.doi.org/10.1046/j.1365-2648.1995.22030502.x
[11] Testa, M.A. and Simonson, D.C. (1996) Assessment of Quality-of-Life Outcomes. New England Journal of Medicine, 334, 835-840.
http://dx.doi.org/10.1056/NEJM199603283341306
[12] Hunt, S.M., McEwen, J. and McKenna, S. (1986) Measuring Health Status. Croom Helm, London.
[13] The EuroQol Group (1990) EuroQol—A New Facility for the Measurement of Health-Related Quality of Life. Health Policy, 16, 199-208.
http://dx.doi.org/10.1016/0168-8510(90)90421-9
[14] Bowling, A. (2005) Measuring Health: A Review of Quality of Life Measurement Scales. Open University Press, Berkshire.
[15] Orthopedic Scores (2006) Oxford Knee Score.
http://www.orthopaedicscore.com/
[16] Weiss, J.M., Noble, P.C., Conditt, M.A., Kohl, H.W., Roberts, S., Cook, K.F., Gordon, M.J. and Mathis, K.B. (2002) What Functional Activities Are Important to Patients with Knee Replacements. Clinical Orthopaedics and Related Research, 172-188.
[17] Townsend, P. (1987) Deprivation. Journal of Social Policy, 16, 125-146.
http://dx.doi.org/10.1017/S0047279400020341
[18] Townsend, P., Phillimore, P. and Beattie, A. (1988) Health and Deprivation: Inequality and the North. Croom Helm, Bristol.
[19] Jarman, B. (1984) Underprivileged Areas: Validation and Distribution of Scores. British Medical Journal, 289, 1587-1592.
http://dx.doi.org/10.1136/bmj.289.6458.1587
[20] Cotterill, S. (2005) A Comparison of Deprivation Indices: Townsend 4 and Index of Multiple Deprivation 2004. Key Health Data for the West Midlands, University of Birmingham, Birmingham.
[21] Dolan, P. (1996) Modelling Valuations for Health States: The Effect of Duration. Health Policy, 38, 189-203.
http://dx.doi.org/10.1016/0168-8510(96)00853-6
[22] Mansel, R., Locker, G., Fallowfield, L., Benedict, A. and Jones, D. (2007) Cost-Effectiveness Analysis of Anastrozole vs. Tamoxifen in Adjuvant Therapy for Early Stage Breast Cancer in the United Kingdom: The 5-Year Completed Treatment Analysis of the ATAC (“Arimidex”, Tamoxifen Alone or in Combination) Trial. British Journal of Cancer, 97, 152-161.
http://dx.doi.org/10.1038/sj.bjc.6603804

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.