Friday, April 13, 2012

Predictors of Outcome in Joint Replacement

Much of this work as been done with respect to total knees, but there's every reason to believe that the same predictors would apply to shoulder surgery.

These factors include

Body Mass Index (BMI) - disproportionately heavy individuals had poorer outcomes

Provider Volume, age, and associated medical conditions - Higher revision rates were associated with lower patient age and low hospital volume. Complications during admission were associated with increased patient age and comorbidity, and higher hospital volume.

Catastrophizing and depressive symptoms - depressive symptoms were predictors of greater global pain complaints, while catastrophizing was a specific predictor of elevated nighttime pain.

Preoperative pain and function. - the strongest determinant of outcome was pre-operative pain and function (less severe patients had the best outcomes)

Poor preoperative comfort, function, and mental health -  the most significant preoperative predictors of worse preoperative scores on the pain,  physical functioning and mental health.

These results are important in that they suggest that the route to better results may lie more in understanding and managing these risk factors than in improvement in prosthetic design.  They surely need to be covered in preoperative discussions with patients with such findings.


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