Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 2--estimated lifetime incremental cost-utility ratios.

Background Context: Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been widely accepted as highly cost-effective procedures, spine surgery for the treatment of degenerative conditions does not share the same perception among stakeholders. In particular, the sustainability of the outcome and cost-effectiveness following lumbar spinal stenosis (LSS) surgery compared with THA/TKA remain uncertain.

Purpose: The purpose of the study was to estimate the lifetime incremental cost-utility ratios for decompression and decompression with fusion for focal LSS versus THA and TKA for osteoarthritis (OA) from the perspective of the provincial health insurance system (predominantly from the hospital perspective) based on long-term health status data at a median of 5 years after surgical intervention.

Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values.

Background: Demand for surgery to treat osteoarthritis (OA) of the hip, knee and spine has risen dramatically. Whereas total hip (THA) and total knee arthroplasty (TKA) have been widely accepted as cost-effective, spine surgeries (decompression, decompression with fusion) to treat degenerative conditions remain underfunded compared with other surgeries.

Methods: An incremental cost-utility analysis comparing decompression and decompression with fusion to THA and TKA, from the perspective of the provincial health insurance system, was based on an observational matched-cohort study of prospectively collected outcomes and retrospectively collected costs.

Developing a decision aid to guide public sector health policy decisions: a study protocol.

Background: Decision aids have been developed in a number of health disciplines to support evidence-informed decision making, including patient decision aids and clinical practice guidelines. However, policy contexts differ from clinical contexts in terms of complexity and uncertainty, requiring different approaches for identifying, interpreting, and applying many different types of evidence to support decisions. With few studies in the literature offering decision guidance specifically to health policymakers, the present study aims to facilitate the structured and systematic incorporation of research evidence and, where there is currently very little guidance, values and other non-research-based evidence, into the policy making process.

A multidisciplinary systematic review of the use of diagrams as a means of collecting data from research subjects: application, benefits and recommendations.

Background: In research, diagrams are most commonly used in the analysis of data and visual presentation of results. However there has been a substantial growth in the use of diagrams in earlier stages of the research process to collect data. Despite this growth, guidance on this technique is often isolated within disciplines.

Outcomes of total joint arthroplasty in academic versus community hospitals.

Background: Most joint-replacement surgeries are currently performed in community hospitals. We sought to determine whether the functional outcomes of joint-replacement surgery differ between academic and community hospitals.

Methods: We surveyed 471 patients for demographic data, Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores and Medical Outcomes Study Short Form 36 (SF-36) scores at baseline and at 3-month and 1-year follow-up.

Metabolic syndrome and the incidence of symptomatic deep vein thrombosis following total knee arthroplasty.

Objective: We asked if patients with metabolic syndrome undergoing total knee replacement (TKR) have an increased risk for symptomatic deep vein thrombosis (DVT) at 3 months followup.

Methods: We reviewed 1460 patients from our joint registry undergoing primary, unilateral TKR between 1998-2006. Demographic variables of age, sex, comorbidity, and education were retrieved.

Predicting the longer term outcomes of total knee arthroplasty.

We asked the question of what are the patient level predictors (age, gender, body mass index, education, ethnicity, mental health, and comorbidity) for a sustained functional benefit at a minimum of 1 year follow-up after total knee arthroplasty(TKA). Five hundred fifty-one consecutive patients were reviewed from our joint registry between the years of 1998 and 2005. Baseline demographic data and the outcome scores of the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Short-Form 36 (SF36) scores were extracted from the database.

Greater perceived helplessness in osteoarthritis predicts outcome of joint replacement surgery.

Objective: To determine if there is a difference between male and female patients in their perceived control of osteoarthritis (OA) symptoms at the time of joint replacement surgery, as measured by the Arthritis Helplessness Index (AHI), and how this helplessness affects surgical outcomes at 1 year.

Methods: From a joint replacement registry, 70 male and 70 female patients were randomly selected and matched for age, body mass index, comorbidity, procedure, and education. Patients completed the AHI prior to surgery.

Asian ethnicity and the prevalence of metabolic syndrome in the osteoarthritic total knee arthroplasty population.

Metabolic syndrome (MS) is a known risk factor for the development of osteoarthritis (OA). We asked whether the prevalence of MS varies across ethnicity among patients who undergo total knee arthroplasty for end-stage OA. In our population of 1460 patients undergoing primary knee arthroplasty, MS was defined as body mass index greater than 30 kg/m(2), diabetes, hypertension, and hypercholesterolemia.

High-flexion implants in primary total knee arthroplasty: a meta-analysis.

Background: We asked whether a high-flexion design implant improves patient functional outcomes or range of motion (ROM) after primary knee arthroplasty.

Methods: We searched the major medical databases for randomized trials and comparison observational studies comparing high-flexion and conventional knee implants. After testing for publication bias and heterogeneity, the data were aggregated by random effect modeling.