UMass study looks at joint replacement surgery (Telegram)
University of Massachusetts Medical School researchers are touting — in a prestigious journal — a model they have developed to better understand the outcome of total joint replacement surgeries, from the patient’s perspective.
A team of medical school researchers is in the second year of a four-year, $12 million federal grant to enroll 33,000 total joint replacement recipients in a registry and analyze the data. Researchers at the school are trying to understand what practices and circumstances contribute to a successful replacement.
So far, the school has recruited more than 100 surgeons and nearly 7,000 patients across the country. While the data collection is ongoing, a group of medical school professors described their new approach to the medical community in an article in the Sept. 26 edition of the Journal of The American Medical Association.
“What’s different about this approach is that it is patient-centered,” said Dr. David Ayers, chairman of orthopedics and physical rehabilitation at the medical school.
The medical school researchers said, while most total joint replacements are successful, the effectiveness of the procedure matters a great deal as the population ages.
The highest volume and costliest procedure in the Medicare budget is joint replacement, and it is projected to grow exponentially, according to Dr. Patricia D. Franklin, a UMass professor. At the same time, 40 percent of people who underwent the procedure last year were younger than 65, she said.
The medical school’s data so far shows people younger than 65 are going through the procedure for similar reasons as older patients, because of arthritic pain and disability, Dr. Franklin said.
“With the baby boomer generation, they are experiencing arthritic symptoms at an earlier age, perhaps due to an injury or sporting injury or event or a lifetime of activities,” Dr. Ayers said.
In the past, orthopedic registries focused on the implants, not the patients, and replacement surgeries were deemed a success or failure simply depending on whether or not the implant was removed at a later date, said Dr. Ayers, who wrote the JAMA article with Dr. Franklin and Dr. Jeroan Allison, also a UMass professor.
Their approach to creating a registry takes into account whether the quality of life for the patient with the implant is improving, in terms of pain relief and their ability to function, Dr. Ayers said.
While the researchers set out to establish a cohort of recipients between 2011 and 2014, they anticipate continuing the effort for years after the initial period in order to track outcomes, said Dr. Franklin, the project’s primary investigator.
The participating surgeons perform a total of 15,000 operations or more a year, so the project leaders expect to reach their goal of enrolling 33,000 patients by the end of the four-year period, said Dr. Franklin, a professor of orthopedics, physical rehabilitation, family medicine and community health.
When prospective patients are evaluated for surgery they are invited to participate in the registry if they are willing, she said.
“Patients have been very engaged and compliant, because it is a big decision to have a total joint replacement, and they are pleased that we are asking about pain, function and their experience,” she said.
Following a surgery, the medical school will contact recipients at regular intervals — six months, a year, two years and longer — and the patients are asked about how they are doing with their pain and physical functioning, she said.
Since the school established a direct relationship with the patients it is able to track them, even if they move and are no longer meeting with their original doctors.
In addition to establishing an approach and gathering the data, the medical school’s researchers will seek to answer critical questions based on the information that they gather. They will try to learn more about what circumstances lead to better outcomes, from patient factors, such as lifestyles or weight, to different surgical approaches and hospital settings, the two professors said.
“What the analysis will tell us is what is the best practice, what gets the best results after hip or knee replacement,” Dr. Ayers said.
The medical researchers will publish their findings, along with a summary of the data. In the meantime, participating surgeons have access to the raw data collected on their patients, allowing them to monitor the effectiveness of surgeries that they have performed.
The school’s efforts could provide the health care industry with useful information, Dr. Ayers said.
“It has enormous potential to be used to help hospitals or insurance companies to look at their patients and determine what their patient outcomes are in comparison to our national sample,” he said.