Objective. To compare quality of life (QOL) scores 3 and 10 years after total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis with QOL scores in a general population, and to determine factors associated with QOL after surgery. Methods. Data were obtained from 2 multicenter cohorts of patients with THA or TKA: 232 patients were recruited during 2003 (3-year cohort) and 221 patients were recruited during 1994 (10-year cohort). Preoperative data (QOL, radiograph results) and followup data (demographics, comorbidities, pain locations, environmental factors, and QOL) were collected. QOL data for the general population were obtained from a 2003 population-based survey. Results. A total of 195 and 89 patients for the 3-and 10-year cohorts, respectively, were followed up; the mean age at followup was 73 years. For both of the cohorts, physical functioning and role-physical or role-emotional QOL scores were lower than those for a general population with comparable age. Scores for pain, mental health, and social dimensions were lower than those for the reference population for only the 10-year cohort. For both cohorts, increased number of comorbidities, painful locations other than THA or TKA location, and unfavorable environmental factors were associated with impaired QOL. Low preoperative QOL scores were predictive of impaired QOL at followup for only the 3-year cohort. Conclusion. THA or TKA can improve QOL, but the benefits may be time limited. Addressing environmental factors and treating comorbidities and pain in locations other than the arthroplasty location could have mid-and long-term effects on the QOL of patients with THA or TKA.

BackgroundInpatient satisfaction with care is a standard indicator of the quality of care delivered during hospitalization. Total hip and knee replacement (THR/TKR) for osteoarthritis (OA) are among the most successful orthopaedic interventions having a positive impact on health-related quality of life (HRQoL). The aim was to evaluate the effect of satisfaction shortly after hospital discharge on 1-month, 6-month and 1-year Medical Outcomes Study 36-item Short Form (SF-36) scores for OA patients after THR and TKR, controlling for patient characteristics, clinical presentation and preoperative SF-36 scores.MethodsA multicenter prospective cohort study recruited 231 patients with OA scheduled to receive THR or TKR. Satisfaction was assessed by the Patients Judgment of Hospital Quality (PJHQ) questionnaire and HRQoL by the SF-36 questionnaire. Linear models for repeated measures assessed the relation between satisfaction (scores were dichotomized) and postoperative SF-36 scores.ResultsOf 231 participants, 189 were followed up 12 months after discharge (mean age 69 SD = 8; 42.6% male). The mean length of hospital stay was 13.5 (SD = 4) days. After adjustment for preoperative SF-36 scores, sociodemographic and clinical patient characteristics, satisfied patients (PJHQ score > 70) had higher SF-36 scores 1 year after surgery than did less-satisfied patients. Admission, medical care, and nursing and daily care scores mainly predicted bodily pain, mental health, social functioning, vitality and general health scores of the SF-36.ConclusionBesides being a quality-of-care indicator, immediate postoperative patient satisfaction with care may bring a new insight into clinical practice, as a predictor of self-perceived health status after surgery.

We conducted a multicentre cohort study of 228 patients with osteoarthritis followed up after total hip or knee replacement. Quality of life and patient satisfaction were assessed by self-administered questionnaires. Patient satisfaction was the dependent variable in a multivariate linear regression model. Independent variables included sociodemographic factors, pre- and post-operative clinical characteristics and the pre-operative and post-discharge health-related quality of life. The mean age of the patients was 69 years (sd 9), and 43.8% were male. Pre- and postoperative clinical characteristics were not associated with satisfaction with health care. Only pre-operative bodily pain (p<0.01) and pre-operative social functioning (p<0.05) influenced patient satisfaction with care. The pre-operative health-related quality of life and patient characteristics have little effect on inpatient satisfaction with care. This suggests that the impact of the care process on satisfaction may be independent of observed and perceived initial patient-related characteristics.