Privat-docent thesis
English

Learning health system in total knee arthroplasty: action!

Defense date2022-02-07
Abstract

Total knee arthroplasty (TKA) is widely used as a treatment of end-stage osteoarthritis (OA). Given the prevalence of OA, the aging population, an increased demand for quality-of-life years, and the access to medical care, the number of TKA worldwide has grown and is expected to grow further steadily. Despite many decades since the first (non-hinged) TKA in the late sixties, results shows a stagnating patients' satisfaction rate, ranging from 80 to 85%. Many factors do play a role, patients' related (age, sex, BMI, comorbidities, expectations …), implant related (prosthetic design, constraint, material, fixation …), technique related (alignment philosophy, surgical technique), perioperative patient management and, last but not least, indication for surgery (right indication at the right moment). Research in the field is paramount to enhance the results of knee arthroplasty. Nevertheless, knowledge should reach the different stakeholders, at last, and peerreviewed literature alone is not enough to disseminate health care transformations (1). Indeed, to change practices to better and more affordable care, we require a profound transformation in how health systems generate and apply knowledge (2), with a lag time for academic publications as short as possible to implement ongoing health care delivery. The concept of rapid-learning health care (3) is a growing in interest, because it provides a fast, real-time two-ways learning, where scientific sound evidence reaches practice and practice generates knowledge for evidence (1). The model is similar to the cycle Plan, Do, Check, Act popularized by Demings, and as any other project, requires a culture and a structure ready for a disruptive change to switch from a concept to action. In this regard, reviewing data from our prospective local hospital-based knee arthroplasty registry (Geneva Arthroplasty Registry) and from gait analysis studies performed at the Willy Taillard laboratory of kinesiology at the Geneva University Hospitals, led to different peer-reviewed publications which has been translated into clinical practice to help improve results after primary TKA. The translation goes beyond the surgeons' perspective (better implant positioning and alignment, better TKA stability, a sound implant choice) and implies patients' advising in the shared decision-making process for surgery (can and do we meet the expectations?), as well as better care before, during and after surgery. The ultimate goal: a higher satisfaction rate with a long-lasting, revision-free forgotten joint.

Keywords
  • Total knee arthroplasty (TKA)
Citation (ISO format)
MIOZZARI, Hermès Howard. Learning health system in total knee arthroplasty: action! Privat-docent Thesis, 2022. doi: 10.13097/archive-ouverte/unige:159042
Main files (1)
Thesis
accessLevelRestricted
Identifiers
207views
4downloads

Technical informations

Creation18/02/2022 12:33:00
First validation18/02/2022 12:33:00
Update time16/03/2023 02:41:59
Status update16/03/2023 02:41:57
Last indexation01/11/2024 00:55:04
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack