What makes a knee or hip replacement a failure?

Failure of total joint replacement (TJR) is characterized by lack of pain relief or restoration of function or quality of life (QoL), or the occurrence of surgical complications after TJR, according to the participants of a recent study. Additionally, functional TJR failure can then be considered as essential or more important than surgical failure.

The investigators used the nominal group technique (NGT) with participants who had undergone elective total hip replacements (THR) or TJR to answer the following question: When would you consider a knee or hip replacement to be a failure?

Eight nominal groups with 42 participants were formed, all of whom had undergone THR or TJR between 2016 and 2018. Of the participants, 48 percent were male, 17 percent were Black, 79 percent had college education or above, and 76 percent had had osteoarthritis as the underlying diagnosis.

The nominated responses/themes ranked the highest by participants were refractory index joint pain (80 votes), followed by occurrence of postoperative adverse events (54 votes) and unable to resume normal activities or go back to work (38 votes).

Other responses/themes included were as follows: little or no improvement in QoL (35 votes), early revision surgery (35 votes), death (7 votes), and others, including nurse or physician negligence (2 votes) and expectation-outcome mismatch (1 vote).

“This patient perspective emphasizing pain, function, satisfaction, adverse events, and revision as critical domain components of TJR failure independently validated their inclusion in the TJR core domain set for clinical trials in people undergoing knee or hip TJR,” the investigators said.