Assessing the outcomes of total knee replacement

The past few years have seen a growth of interest in outcome measurement in a variety of settings including audit, health care management and commissi oning - besides the traditional applications in research work. This paper r eports on a study of the outcomes of total knee replacement in an acute hos pital where the outcomes were studied as part of an audit process. The outc ome measures used included clinical and symptomatic measures as well as gen eric health status scales. The initial study in one hospital was expanded t o include a number of others in the same region and a comparative database of outcomes developed. Examples of the results are shown. The technical mea sures using knee scores and general health status measure show significant improvement from pre-operatively to 3 months later. This improvement was ma intained up to the 1-year follow-up on both measures. Although the informat ion systems for collecting and measuring outcomes has been successful, the ability of such measures to lead to behavioural change has been limited. Th e problems in using outcome measures are discussed in particular in the con text of an audit within hospitals, and for purchasing agencies.