The Value of a Standardized Knee Functional Assessment in Predicting the Outcomes of Total Knee Arthroplasty

Abstract

Questionnaires and physical tests are tools to determine the ability of an individual to perform tasks of the daily living. In our institution, a standardized knee performance evaluation including patient-reported outcome measures (PROMs) and physical performance tests has been applied to all patients undergoing total knee arthroplasty (TKA). Our goal was to identify which preoperative tools influence the outcomes of a TKA and if physical performance tests can be of value if used along with PROMs in predicting functional outcomes. Classification and regression tree was used to analyze which preoperative factors influence function after TKA. Western Ontario and McMaster Universities Arthritis Index (WOMAC) function (WOMAC-F), 6-minute walk test (6MWT), and timed up and go (TUG) test at the 12th postoperative month were the dependent variables. Age, body mass index, preoperative WOMAC function and pain score, muscle strength, 6MWT, and TUG test score were used as preoperative predictors of dependent variables. TUG ≤19.3 seconds and age <62 years were preoperative predictors of better scores in the WOMAC-F (5.5). Strength of extensor muscles of the nonoperated knee ≥99.43 N·m/kg and 6MWT> 328 m were preoperative predictors of a better postoperative 6MWT (499 m). TUG <12.3 seconds and 6MWT ≥421 m were preoperative predictors of better postoperative TUG (7.3 seconds). Preoperative performance in physical tests had an influence on postoperative outcome scores than PROMs after TKA. Less age, good muscular strength, greater capacity of walking, and smaller TUG times were associated with better outcomes.

Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis

“…It should be noted that 5 studies exclusively recruited women ( 52 – 56 ), in one study only men were included ( 51 ), one study did not provide information on the sex ( 35 ) and in 3 studies the mean age was not provided or specified ( 49 , 55 , 57 ). The youngest average age was 24.1 ( 58 ) and the oldest 80.5 ( 59 ).…”

“…Among the 31 included studies, 29 were observational (15 were cross-sectional ( 12 , 52 , 53 , 55 , 56 , 58 – 67 ), 7 retrospective ( 28 , 35 , 48 , 49 , 68 – 70 ), 6 prospective ( 51 , 57 , 71 – 74 ) and 1 combined analysis of retrospective and prospective occurrences ( 75 ) in cohort studies) and 2 were interventional [clinical trials ( 50 , 54 )]. BMI classification was monitored for all the included studies according to the WHO standards; however, not all the studies made use of a complete subclassification stratified in four classes.…”

“…Most studies classified the participants in normal range (BMI: 18.5-24.9), overweight or pre-obesity (BMI: 25.0-29.9) and obesity (BMI ≥ 30.0) ( 28 , 48 , 49 , 51 , 52 , 54 , 56 , 63 – 66 , 72 – 74 ). However, 10 articles ( 35 , 51 , 52 , 58 – 60 , 62 , 63 , 68 , 70 ) recruited underweight patients, of which 3 studies ( 52 , 63 , 70 ) added such data to the normal range category, and two ( 51 , 68 ) left them out of their quantitative analysis. Although a subclassification for obesity was carried out in 11 studies ( 12 , 49 , 55 , 57 , 59 , 60 , 65 – 68 , 70 ), none included the same subgroups in their studies.…”

“…Finally, subjective pain intensities were assessed as the means of different pain-rating scales: VAS ( 28 , 53 , 55 , 56 , 58 , 63 , 64 , 66 , 72 , 74 ) and NRS ( 12 , 35 , 48 – 54 , 57 , 59 – 63 , 65 , 67 – 71 , 73 , 75 , 76 ) (alternatively named NPRS). The main selected descriptive characteristics of the studies are summarized in Table 1 .…”

Factors Affecting the Length of Convalescent Hospital Stay Following Total Hip and Knee Arthroplasty

“…20 , 21 , 28 ) Several studies have demonstrated that preoperative and early postoperative TUG times are useful for predicting both short- and long-term mobility function following lower-limb arthroplasty. 29 , 30 ) In patients after THA, one previous study suggested that the TUG test in the early stage was an effective indicator to predict ambulation ability at 6 months after surgery. 31 ) Poitras et al reported that the preoperative and postoperative day 2 TUG time could indicate hospital LOS and short-term functional capacity.…”