LAUSR

Background Utilization rates of total joint replacements (TJR) are high and rising to treat advanced symptomatic arthritis, but there is little qualitative research to define the most important outcomes from the patient perspective. Objectives To assess the most important outcomes of TJR from the patients’ perspective using nominal group technique (NGT). Methods Recruited patients were ≥18 and had received total hip (THR) or total knee replacements (TKR). Participants completed a questionnaire including demographics and pain and function measures, and answered “What result/results matter the most to a patient undergoing/having a knee or hip replacement?”. Outcomes were independently selected, listed in a round robin, and ranked by the group using NGT. Results 36 patients participated in 6 nominal groups in January 2019. 42% were men (Table 1 ). For THR, 94% reported no/mild pain. For TKR, 81% reported no/mild pain pivoting or on stairs, 1 patient reported severe pain. Satisfaction was high, 97% reported very/somewhat satisfied with pain relief. Of 216 total votes, A) pain received 98 votes, B) function 52; C) quality of life 40; D) adverse events 16 votes and E) revision 2 votes, the remainder 8 votes were distributed to post-op concerns including access to rehabilitation or education (Table 2). Conclusion Pain, function, quality of life, and adverse events are the outcomes ranked highest by patients, supporting their inclusion in TJR clinical trials.Abstract AB1213 Table 1 Baseline Characteristics Age (mean, years) 75.7±8.2 65.9±8.1 66.3±5.4 71.1±9.3 Men, n(%) 6 (31.6) 8 (57.1) 1 (33.3) 15 (41.7) Black, n(%) 3 (15.8) 3 (21.4) - 6 (16.7) Asian, n(%) - - 1 (33.3) 1 (2.8) Multi-race, n(%) 1 (5.3) 1 (7.1) 2 (5.6) Education High school, n(%) - 1(7.1) - 1 (2.8) Some college, n(%) 1(5.3) 3(21.4) 4 (11.1) College or above, n(%) 18 (94.7) 10 (71.4) 3 (100) 31 (86.1) Employment Employed for wages, n(%) 3 (15.8) 9 (64.3) 3(100) 15 (41.7) Self-employed, n(%) 4 (21.1) 3(21.4) - 7 (19.4) Out of work but not looking for work, n(%) 1(5.3) - - 1 (2.8) Retired, n(%) 11 (57.9) 2 (14.3) - 13 (36.1) Reason for surgery Osteoarthritis, n(%) 13 (68.4) 12 (85.7) 3(100) 28 (77.8) Rheumatoid arthritis, n(%) 2 (10.5) 1(7.1) - 3 (8.3) Other arthritis, n(%) 3 (15.8) 1(7.1) - 4 (11.1) Avascular necrosis of the bone, n(%) 1(5.3) - - 1 (2.8)Abstract AB1213 Table 2 Theme: What result/results matter the most to a patient undergoing a hip or knee replacement? NG1-6, 36 people, 14 Male, 22 Female; 8 African-American, 26 White, 2 Asian; 216 votes* A. Pain: No more pain/to be pain free. “Goes beyond physical pain, isolates you, not living the way you’re used to living”. “You’re a slave to the joint” 98 B. Function: Regaining range of motion/mobility/able to carry out ADL (activities of daily living). “Has some emotional impact – when I was able to put my socks on without pain for the first time I had tears in my eyes” 52 C. Quality of life: Ability to have a normal life. “Before captive to the pain and immobility, now have an ability to be participating in life” 40 D. Adverse events: Not feeling the fear of infection or set back/long term good outcomes. “It’s a horrible thing (infection), it’s a sin that happens” 16 E. Revision: Longevity, no repeated replacement of joint in my lifetime. “The useful life of the replacement” 2 F. Optimization of post-operative care: having a short recovery period. “Prepared for a lengthy recovery – was not an issue, expected a year” 6 G. Education: What to expect with healing. “Know what to expect after surgery” 2 *combined votes; NG= nominal group Disclosure of Interests Susan Goodman Grant/research support from: Novartis: research support, Consultant for: Novartis, UCB, Pfizer: consulting, Bella Mehta: None declared, Serene Mirza: None declared, Mark Figgie: None declared, Peter Sculco: None declared, Michael Parks Grant/research support from: Zimmer Biomet, Employee of: Zimmer Biomet, jasvinder singh Shareholder of: Amarin pharmaceuticals and Viking therapeutics, Consultant for: Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology