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Data Shows National "Norms" for Timing of Hip and Knee Replacements

Could Aid in Shared Physician/Patient Decision-Making

WORCESTER, MA -- (Marketwired) -- 03/07/14 -- Data gathered through a federally funded research registry by more than 125 orthopedic surgeons on 15,000 joint replacement patients across the US has pinpointed "typical" patient pain and function scores at which most patients undergo joint replacement surgery.

"This is the first time we've been able to quantify the point at which most patients and surgeons together make the decision to proceed with a total knee or hip replacement," said David Ayers, MD, Chair of the Department of Orthopedics and Physical Rehabilitation and director of the Musculoskeletal Center of Excellence at the University of Massachusetts Medical School. "We studied the typical orthopedic practice in the United States and found that we were able to statistically identify a point, based on a national sample of patients' reported levels of pain and functional impairment, that surgeons offer surgery and patients decide to move forward."

The uniformity of pain and function scores across such a wide population offers, for the first time, possible national benchmarks that patients and surgeons can use in shared decision-making and for comparison to assess where a patient falls on a spectrum and whether they meet these national "norms" for the timing of surgery.

Surgeons participating in the research program called FORCE-TJR use a proprietary computerized system to collect standardized, validated patient reported outcomes questionnaires (PROs) pre- and post- surgery. The FORCE-TJR system allows knee or hip pain to be quantified and joint pain and stiffness (function) to be scored independently. Together, the data produces a combined physical composite score (PCS) for a patient's level of pain and physical function.

The nationally recognized mean PCS score for an individual with no hip and knee pain or functional difficulty is 50. The FORCE-TJR study across 15,000 patients found that the typical PCS score for a patient at the point they decide to have joint replacement surgery is 32 -- nearly two standard deviations below the norm, representing significant pain and disability.

"PROs provide a valuable tool to guide physician and patient decision-making around the very difficult decision to proceed or not with a joint replacement," said Courtland Lewis, MD, Physician in Chief, Hartford Healthcare Bone & Joint Institute.

Physician use of PROs to guide patient care is a relatively new concept. Few orthopedic research programs and registries have collected standardized patient-reported outcomes (PROs) information, rather focusing on the performance of the actual implant device and the number of revision surgeries to define joint replacement success.

The FORCE-TJR database is expanding that notion to include PROs on pain relief and function as additional important measures of success.

FORCE-TJR surgeons consistently gather validated PROs from their patients pre- and post-surgery. On track to enroll more than 30,000 patients in the program, the FORCE-TJR database is the largest to provide measureable patterns of patient pain, function, mobility, and other health indicators that can help patients and their physicians understand where they fall on a national spectrum of norms both pre- and post- joint replacement.

This data is among the first to be publicly released by the FORCE-TJR consortium.

FORCE-TJR -- Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement -- is federally funded by a $12 million grant from the Agency for Healthcare Research and Quality (AHRQ). The research program is developing a national database of surgical results and patient-reported outcomes that will include at least 30,000 TJR patients. FORCE-TJR is both a research program to develop new knowledge about best practice, as well as a quality monitoring system that provides immediate data to surgeons and hospitals to manage and monitor outcomes. The research, along with recorded patient assessments about the success and failure of their surgeries, will ultimately guide and improve clinical best practices, health care policy and the overall health and quality of life for millions of people suffering from arthritis.

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