Patients with Severe Radiographic Osteoarthritis Have a Better Prognosis in Physical Functioning after Hip and Knee Replacement: A Cohort-Study

Abstract

IntroductionAlthough Total Hip and Knee Replacements (THR/TKR) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations. We aimed to assess whether the pre-operative radiographic severity of osteoarthritis (OA) is related to the improvement in HRQoL after THR or TKR, both at the population and individual level.MethodsIn this multi-center observational cohort study, HRQoL of OA patients requiring THR or TKR was measured 2 weeks before surgery and at 2–5 years follow-up, using the Short-Form 36 (SF36). Additionally, we measured patient satisfaction on a 11-point Numeric Rating Scale (NRSS). The radiographic severity of OA was classified according to Kellgren and Lawrence (KL) by an independent experienced musculoskeletal radiologist, blinded for the outcome. We compared the mean improvement and probability of a relevant improvement (defined as a patients change score≥Minimal Clinically Important Difference) between patients with mild OA (KL Grade 0–2) and severe OA (KL Grade 3+4), whilst adjusting for confounders.ResultsSevere OA patients improved more and had a higher probability of a relevant improvement in physical functioning after both THR and TKR. For TKR patients with severe OA, larger improvements were found in General Health, Vitality and the Physical Component Summary Scale. The mean NRSS was also higher in severe OA TKR patients.DiscussionPatients with severe OA have a better prognosis after THR and TKR than patients with mild OA. These findings might help to prevent dissatisfaction after THR and TKR by means of patient selection or expectation management.

Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study

“…Previously, studies have found that a substantial proportion of TKAs are performed in patients who on radiography appeared to have only mild or moderate knee OA [9,12,14]. Furthermore, only a portion of patients with severe radiographic knee OA end up seeking or undergoing TKA.…”

Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients

“…The KSS, age, process of healthcare and treatment outcomes scores which were significant Table 3. The median treatment outcomes points for Group I were 23 (range 13-28), 16 for Group II (range 13-22) and 14 (13)(14)(15)(16)(17)(18)(19)(20)(21) for Group III.…”

“…Prior studies have focused on patient's expectations and satisfaction influenced by education and income, discord between patient and surgeon recovery expectations, information from the media, information about rehabilitation received from the surgeon, improvements in both pain and physical function scores, preoperative severity of the osteoarthritis, employment, postoperative satisfaction and hospital experience [9,[13][14][15][16][18][19][20][21][22][23]. Moreover, in a systematic review by Haanstra et al [11], the authors highlighted the need for more studies in the field of patient expectations for total joint arthroplasties (TJA).…”

Comparison of Pain and Functional State and Quality of Life of Total Knee Replacement Patient

“…A total knee replacement is an effective surgical intervention for the patients with knee osteoarthritis by reducing pain in the knee joints and enhancing the quality of life and joint functions for a smoother gait. A study of the cohort of patients with total knee replacement showed a significant increase in the Short Form-36 Health Survey (Gidwani, Tauro, Whitehouse & Newman, 2003;Keurentjes et al, 2013). However, all the prognoses of the patients with total knee are positive.…”