Abstract
Objectives
To determine the lifetime quality-adjusted life years (QALYs) gained by total joint
arthroplasty (TJA), and assess the QALYs attributed to specific postoperative rehabilitation
interventions.
Design
Secondary analysis of 2 multicenter, randomized controlled trials (RCTs) with 3-,
6-, 12-, and 24-month follow-up.
Setting
Two university hospitals, 2 municipal hospitals, and 1 rural hospital.
Participants
Patients (N=827) who underwent total hip arthroplasty (THA) or total knee arthroplasty
(TKA).
Interventions
RCT A: 465 patients were randomly assigned to receive aquatic therapy (pool exercises
aimed at training of proprioception, coordination, and strengthening) 6 versus 14
days after THA or TKA. RCT B: 362 patients were randomly assigned to either perform
or not perform ergometer cycling beginning 2 weeks after THA or TKA.
Main Outcome Measure
QALYs, based on the Short Form–6 Dimensions utility, measured at baseline and 3, 6,
12, and 24 months' follow-up.
Results
After hip arthroplasty, the lifetime QALYs increased by 2.35 years in the nonergometer
group, and by 2.30 years in the early aquatic therapy group. However, after knee arthroplasty,
the lifetime QALYs increased by 1.81 years in the nonergometer group, and by 1.60
years in the early aquatic therapy group. By ergometer cycling, .55 additional QALYs
could be gained after hip and .10 additional QALYs after knee arthroplasty, while
the additional QALYs attributed to the timing of aquatic therapy were .12 years after
hip and .01 years after knee arthroplasty.
Conclusions
This analysis provides a sound estimate for the determination of the lifetime QALYs
gained by THA and TKA. In addition, this analysis demonstrates that specific postoperative
rehabilitation can result in an additional mean QALY gain of .55 years, which represents
one fourth of the effect of surgery. Even if this is interpreted as a small effect
at an individual level, it is important when extrapolated to all patients undergoing
TJA. At a national level, these improvements appear to have a similar magnitude of
QALY gain when compared with published data regarding medications to lower blood pressure
in all persons with arterial hypertension.
Keywords
List of abbreviations:
CI (confidence interval), EQ-5D (EuroQol–5 Dimensions), HRQoL (health-related quality of life), QALY (quality-adjusted life year), RCT (randomized controlled trial), SF-6D (Short Form–6 Dimensions), THA (total hip arthroplasty), TJA (total joint arthroplasty), TKA (total knee arthroplasty)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 11, 2016
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 The American Congress of Rehabilitation Medicine.
