Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions...

The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

Objectives: To investigate the factors which influence patient satisfaction with surgical services and to explore the relationship between overall satisfaction, satisfaction with specific facets of outcome and measured clinical outcomes (patient reported outcome measures (PROMs)). Design: Prospective cohort study. Setting: Single National Health Service (NHS) teaching

https://bmjopen.bmj.com/content/bmjopen/3/4/e002525.full.pdf

What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement

Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink

Background:

Acute compartment syndrome is both a limb- and life-threatening emergency that requires prompt treatment. To avoid a delay in diagnosis requires vigilance and, if necessary, intracompartmental pressure measurement. This review encompasses both limb and abdominal compartment syndrome, including aetiology, diagnosis, treatment and outcome.



Methods:

A Pubmed and Cochrane database search was performed. Other articles were cross-referenced.



Results and conclusion:

Diagnosis of limb compartment syndrome is based on clinical vigilance and repeated examination. Many techniques exist for tissue pressure measurement but they are indicated only in doubtful cases, the unconscious or obtunded patient, and children. However, monitoring of pressure has no harmful effect and may allow early fasciotomy, although the intracompartmental pressure threshold for such an undertaking is still unclear. Abdominal compartment syndrome requires measurement of intra-abdominal pressure because clinical diagnosis is difficult. Treatment is by abdominal decompression and secondary closure. Both types of compartment syndrome require prompt treatment to avoid significant sequelae. © 2002 British Journal of Surgery Society Ltd

Acute compartment syndromes

http://wisitmax.com/img/researchexp/stanford/wearablegait/2014_GaitAndPosture.pdf

Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention

We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.

Acute compartment syndrome: WHO IS AT RISK?

The aim of this study was to perform a cost–utility
analysis of total hip (THR) and knee replacement (TKR). Arthritis is
a disabling condition that leads to long-term deterioration in quality
of life. Total joint replacement, despite being one of the greatest
advances in medicine of the modern era, has recently come under
scrutiny. The National Health Service (NHS) has competing demands,
and resource allocation is challenging in times of economic restraint. Patients
who underwent THR (n = 348) or TKR (n = 323) between January and
July 2010 in one Scottish region were entered into a prospective
arthroplasty database. A health–utility score was derived from the
EuroQol (EQ-5D) score pre-operatively and at one year, and was combined
with individual life expectancy to derive the quality-adjusted life years
(QALYs) gained. Two-way analysis of variance was used to compare
QALYs gained between procedures, while controlling for baseline
differences. The number of QALYs gained was higher after THR than
after TKR (6.5 vs 4.0 years, p < 0.001). The
cost per QALY for THR was £1372 compared with £2101 for TKR. The
predictors of an increase in QALYs gained were poorer health before
surgery (p < 0.001) and younger age (p < 0.001). General health
(EQ-5D VAS) showed greater improvement after THR than after TKR
(p < 0.001). This study provides up-to-date cost-effectiveness
data for total joint replacement. THR and TKR are extremely effective
both clinically and in terms of cost effectiveness, with costs that
compare favourably to those of other medical interventions. Cite this article: Bone Joint J 2013;95-B:115–21.

Predicting the cost-effectiveness of total hip and knee replacement: A health economic analysis

/pdf/acute-compartment-syndrome-v1kmonc6ap.pdf

Acute compartment syndrome

Satisfaction with care is important to both patients and to those who pay for it The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the 'friends and family test'; an overarching measure of patient satisfaction It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response Achieving pain relief (odds ratio (OR) 213, confidence interval (CI) 183 to 249), the meeting of pre-operative expectation (OR 257, CI 224 to 297), and the hospital experience (OR 233, CI 203 to 268) are the domains that explain whether a patient would recommend joint replacement services These three factors, combined with the type of surgery undertaken (OR 231, CI 168 to 317), drove a predictive model that was able to explain 95% of the variation in the patient's recommendation response Though intuitively similar, this 'recommendation' metric was found to be materially different to satisfaction responses The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery

Paul Gaston

Papers

Acute compartment syndrome: WHO IS AT RISK?

What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement

Predicting the cost-effectiveness of total hip and knee replacement: A health economic analysis

Acute compartment syndrome

Assessing treatment outcomes using a single question: the net promoter score.