[Clinical pathway for total knee arthroplasty. I: Pathway conception and effect on functional quality of results].
OBJECTIVE
The aim of the current study was to evaluate patient-centred and economic outcomes after introduction of a clinical pathway for total knee arthroplasty.


METHODS
In a prospective trial two sequential cohorts of patients undergoing total knee arthroplasty were recruited. Baseline treatment was surveyed in cohort I and the clinical pathway was developed and evaluated in cohort II. Data from WOMAC, EQ-5D as well as partial cost data were collected. The study design was ratified by the local Independent Ethics Committee.


RESULTS
There was an increase in WOMAC score of 39% for cohort I and 35% for cohort II in 3 months follow-up. Similar results were found for ED-5D with an increase of 30% for cohort I and 25% for cohort II. Partial cost rates could be lowered from 4303 EUR to 419 EUR. Despite this significant cost saving we were not able to improve the ratio of improvement in quality of life to costs.


CONCLUSIONS
With the aid of a clinical pathway the process for implementation of a total knee arthroplasty was improved and treatment quality assured.
Kirschner
S
S
Orthopädische Klinik, Universitätsklinikum Carl Gustav Carus Dresden, 01307, Dresden. Stephan.Kirschner@uniklinikum-dresden.de
Lützner
J
J
Günther
K P
KP
Gonska
M E
ME
Reinicke
K
K
Krummenauer
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000379:methods*; D015331:Cohort Studies; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D007720:Knee Prosthesis / Q000191:economics; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration; D011788:Quality of Life