Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic

Dempsey, Kyle E.; Collins, Jamie E.; Ghazinouri, Roya; Alcantara, Luis; Thornhill, Thomas S.; Katz, Jeffrey N.

doi:10.1093/rheumatology/ket180

Cited by 18 publications

(18 citation statements)

References 17 publications

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“…Although the patients who continued to show a single‐peak pattern at 6 months had a greater improvement in self‐reported function at 6 months compared to the individuals who transitioned from a single peak to double peak after THA, this group had worse self‐reported function prior to surgery. This finding supports previous evidence that patients who self‐reported worse function preoperatively had the greatest capacity to improve following THA 35 …”

Section: Discussionsupporting

confidence: 90%

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Bahl

Arnold

Taylor

et al. 2020

Journal Orthopaedic Research

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Previous studies have established that up to 1 year post total hip arthroplasty (THA), patients do not recover normal function and the magnitude of hip joint loading remains reduced compared to healthy individuals. However, the temporal nature of the loading profile has not been considered to identify individuals who are at a greater risk of poor functional outcomes following THA. This study aimed to determine changes to the profile and magnitude of the resultant hip joint reaction force before and up to 6 months post‐primary THA, and factors associated with atypical loading profiles. Hip joint loading was computed using a personalized lower‐limb musculoskeletal model in 43 participants awaiting primary THA for osteoarthritis (mean age: SD = 65, 14 years; body mass index: SD = 30, 5 kg/m2) before and up to 6 months after THA. Atypical, single‐peak loading profiles were observed for 11 patients before surgery, where four showed a single peak at 6 months. Patients displaying a single‐peak profile walked slower (mean difference: −0.4 m/s) compared to individuals displaying double‐peak profile (P = <.001) and had significantly reduced sagittal plane hip range of motion during gait (mean difference −9.6°, P = <.001). Self‐reported pain, function, and stiffness did not differentiate between patients with a single or double‐peak loading profile. Individuals with a single‐peak force profile did not meet the minimal clinically important hip range of motion during gait and would be classified as low‐functioning THA patients. Clinical Relevance: The temporal nature of the force profile may help to identify individuals who are at the greatest risk of poor functional outcomes after THA.

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Section: Discussionsupporting

confidence: 90%

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Bahl

Arnold

Taylor

et al. 2020

Journal Orthopaedic Research

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“…While equivalent outcomes for pain have been described for patients with RA (4), equivalent outcomes in function have not been described (5). Poor baseline pain and function were significant risk factors for poor outcomes for patients with RA, similar to descriptions for patients with OA (22, 23). In addition, the excellent outcomes for RA patients after TKR occurred in spite of having more comorbidities, another known risk factor for poor outcomes in OA patients after TKR (24).…”

Section: Discussionsupporting

confidence: 68%

Patients with Rheumatoid Arthritis have Similar Excellent Outcomes after Total Knee Replacement Compared with Patients with Osteoarthritis

et al. 2015

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Objective Although new treatments for rheumatoid arthritis (RA) are extremely effective in preventing disease progression, rates of total knee replacement (TKR) continue to rise. The ongoing need for TKR is problematic, especially as functional outcomes have been reported to be worse than in patients with osteoarthritis (OA). The purpose of this study is to assess pain, function, and quality of life 2 years after TKR in a contemporary RA patients, compared to patients with OA. Methods Primary TKR cases enrolled between 5/1/2007 and 7/1/2010 in a single institution TKR registry were eligible for this study. Validated RA cases were compared to OA at baseline and at 2-years. Results We identified 4,456 eligible TKRs, including 136 RA. Compared to OA, RA TKR had significantly worse pre-operative WOMAC pain (55.9 vs. 46.6; p-value<0.0001) and function (58.7 vs. 47.3; p-value<0.0001) , however there were no differences at 2 years. Within RA, there was no difference for patients who used biologic DMARDs vs. those who did not in pain (p-value= 0.41) or function (p-value= 0.39) at 2 years. In a multivariate regression, controlling for multiple potential confounders, there was no independent association of RA with 2-year pain (p-value=0.18) or function (p-value=0.71).Satisfaction was high for both RA and OA. Conclusion RA patients undergoing primary TKR have excellent 2-year outcomes, comparable to OA, in spite of worse pre-operative pain and function. In this contemporary cohort, RA is not an independent risk factor for poor outcomes.

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“…These findings parallel self-reported gains in activities of daily living made by TJA patients in developed countries,( 11 , 27 ) which is noteworthy considering differences in pre-operative function and follow-up care across the study settings, including lack of intensive inpatient and outpatient rehabilitation in the DR.( 28 ) OpWalk Boston patients reported improvements within the context of their personal physical activity demands, which included a wide range of activities (Table 2). These results provide clinicians with information about the types of activities patients returned to following TKR in the Dominican Republic, and may be useful in counseling about physical activity after TKR in a developing nation.…”

Section: Discussionmentioning

confidence: 99%

Physical Activity and Experience of Total Knee Replacement in Patients One to Four Years Postsurgery in the Dominican Republic: A Qualitative Study

Stenquist

Elman

Davis

et al. 2014

Arthritis Care & Research

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Objective Musculoskeletal disorders are the second-leading cause of years lived with disability globally. Total Knee Replacement (TKR) offers patients with advanced arthritis relief from pain and the opportunity to return to physical activity. We investigated the impact of TKR on physical activity for patients in a developing nation. Methods We interviewed 18 Dominican patients (78% female) who received TKR as part of the Operation Walk Boston surgical mission program about their level of physical activity after surgery. Qualitative interviews were conducted in Spanish, and English transcripts were analyzed using content analysis. Results Most patients found that TKR increased their participation in physical activities in several life domains such as occupational or social pursuits. Some patients limited their own physical activities due to uncertainty about medically appropriate levels of joint use and post-operative physical activity. Many patients noted positive effects of TKR on mood and mental health. For most patients in the study, religion offered a framework for understanding their receipt of and experience with TKR. Conclusions Our findings underscore the potential of TKR to permit patients in the developing world to return to physical activities. This research also demonstrates the influence of patient education, culture, and religion on patients’ return to physical activity. As the global burden of musculoskeletal disease increases, it is important to characterize the impact of activity limitation on patients’ lives in diverse settings, and the potential for surgical intervention to ease the burden of chronic arthritis.

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Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic

Cited by 18 publications

References 17 publications

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Patients with Rheumatoid Arthritis have Similar Excellent Outcomes after Total Knee Replacement Compared with Patients with Osteoarthritis

Physical Activity and Experience of Total Knee Replacement in Patients One to Four Years Postsurgery in the Dominican Republic: A Qualitative Study

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