Johannes M Giesinger1, Karlmeinrad Giesinger2, Bruno Federico3, Colin D Howie4, David F Hamilton4. 1. Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Dr. Stumpf Straße 56, 6020, Innsbruck, Austria. johannes.giesinger@iipcor.org. 2. Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. 3. Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy. 4. Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.
Abstract
PURPOSE: The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients. METHODS: Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year. RESULTS: Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.). CONCLUSION: Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice. LEVEL OF EVIDENCE: Retrospective cohort, Level III.
PURPOSE: The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients. METHODS: Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year. RESULTS: Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.). CONCLUSION: Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice. LEVEL OF EVIDENCE: Retrospective cohort, Level III.