Outcomes of total hip and knee replacement: Preoperative functional status predicts outcomes at six months after surgery
✍ Scribed by Paul R. Fortin; Ann E. Clarke; Lawrence Joseph; Matthew H. Liang; Michael Tanzer; Diane Ferland; Charlotte Phillips; Alison J. Partridge; Patrick Bélisle; Anne H. Fossel; Nizar Mahomed; Clement B. Sledge; Jeffrey N. Katz
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 110 KB
- Volume
- 42
- Category
- Article
- ISSN
- 0004-3591
No coin nor oath required. For personal study only.
✦ Synopsis
Objective. To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.
Methods. This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.
Results
. Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement. Conclusion. Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.
Total hip replacement (THR) and total knee replacement (TKR) have revolutionized the treatment of disabling lower extremity osteoarthritis (OA) (1,2). Approximately 270,000 of these procedures are done annually in the US, and an estimated 40,000 in Canada. Although more than 90% of patients experience substantial pain relief, THR and TKR are not without risks. Furthermore, while THR (and perhaps also TKR) may be cost saving from a societal perspective (3), the health care system in the US bears a short-term cost of $20,000/case. Given the risks and costs of THR and TKR, the ideal point at which to perform surgery in the course of arthritis is a crucial parameter that remains to be defined. Traditional orthopedic practice has been to delay surgery until pain and functional limitation are intolerable. It has been suggested that earlier surgery may decrease the length of stay and prevent loss in quality of life and function ( ), but this assertion has not