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Research ArticleAccepted Article

When has a knee or hip replacement failed? A patient perspective

Jasvinder A. Singh, Bella Mehta, Serene Z. Mirza, Mark P. Figgie, Peter Sculco, Michael Parks and Susan M. Goodman
The Journal of Rheumatology December 2019, jrheum.191024; DOI: https://doi.org/10.3899/jrheum.191024
Jasvinder A. Singh
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Bella Mehta
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Serene Z. Mirza
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Mark P. Figgie
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Peter Sculco
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Michael Parks
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Susan M. Goodman
Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233; Department of Medicine and Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street New York, NY 10021. Grant Support: JAS is supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. No grant funding was obtained for this study. Financial Conflict: There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. SMG has research support from Novartis and Horizon Therapeutics, and has received consulting fees from Novartis, UCB, and Pfizer. Address correspondence to Jasvinder A. Singh, MBBS, MPH, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294. E-mail: Jasvinder.md@gmail.com
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Abstract

Objective To perform a qualitative study to define the patient perspective of what constitutes a failure of total joint replacement (TJR).

Methods We used the nominal group technique (NGT) with participants who had undergone elective total hip replacements (THR) and/or total knee replacements (TKR) to answer the question “When would you consider a knee or hip replacement to be a failure?”

Results We performed eight nominal groups with 42 participants, all of whom had undergone THR and/or TKR between 2016 and 2018. Of these, 48% were male, 17% black, 79% had college education or above, and 76% had had osteoarthritis as the underlying diagnosis. The nominated responses/themes that were ranked the highest by the participants were: (1) refractory index joint pain (80 votes); (2) occurrence of post-operative adverse events (54 votes); (3) Unable to resume normal activities or go back to work (38 votes); (4) little or no improvement in quality of life (QOL; 35 votes); (5) early revision surgery (35 votes); (6) death (7 votes); and (7) other including nurse or physician negligence (2 votes) and expectation-outcome mismatch (1 vote).

Conclusion Lack of relief of pain or restoration of function or quality of life or the occurrence of surgical complications after TJR were defined as TJR failure by participants. Functional TJR failure seems as or more important than surgical failure. This patient perspective of TJR failure further confirmed their inclusion in core domain set for TJR clinical trials in people undergoing knee or hip replacements.

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The Journal of Rheumatology
Vol. 48, Issue 1
1 Jan 2021
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Accepted manuscript
When has a knee or hip replacement failed? A patient perspective
Jasvinder A. Singh, Bella Mehta, Serene Z. Mirza, Mark P. Figgie, Peter Sculco, Michael Parks, Susan M. Goodman
The Journal of Rheumatology Dec 2019, jrheum.191024; DOI: 10.3899/jrheum.191024

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Accepted manuscript
When has a knee or hip replacement failed? A patient perspective
Jasvinder A. Singh, Bella Mehta, Serene Z. Mirza, Mark P. Figgie, Peter Sculco, Michael Parks, Susan M. Goodman
The Journal of Rheumatology Dec 2019, jrheum.191024; DOI: 10.3899/jrheum.191024
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