Fortin PR, Clarke AE, Joseph L, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

Arthritis & Rheumatology (Impact Factor: 7.87). 04/2001; 42(8):1722 - 1728. DOI: 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>3.0.CO;2-R

ABSTRACT 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.ResultsTwo 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.

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Available from: Matthew H Liang, Oct 31, 2014
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    • "As postoperative ambulation ability is an important factor for living an active life and independently performing daily activities, many patients wish to improve their postoperative ambulation ability. Several studies suggest that poor preoperative functional status is associated with poorer outcome after THA [4] [8]. Several parameters have been considered as possible preoperative predictors of ambulation outcome after THA in patients with OA. "
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    ABSTRACT: The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA) and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC) curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS); and the Timed Up and Go (TUG) test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength (β = -0.379, R (2) = 0.409) at 3 weeks, hip abductor strength (β = -0.572, R (2) = 0.570) at 4 months, and age (β = 0.758, R (2) = 0.561) at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56 Nm/kg for knee extensor strength, 0.24 Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA.
    08/2014; 2014:861268. DOI:10.1155/2014/861268
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    • "A combination of more pain preoperatively , higher age and postoperative low back pain predicts a worse outcome after THR in WOMAC PF after 3.6 years of follow-up (Nilsdotter et al. 2003). Function and pain in patients with lower preoperative physical function does not to improve postoperatively to the level achieved by those with higher preoperative function (Fortin et al. 1999). Old age predicts a poor postoperative outcome after THR and this is consistent with the impression that older people with self reported conditions restricting mobility in addition to arthritic pain in the hip or knee are at higher risk of psychological distress and physical dysfunction (Nilsdotter et al. 2003, Hopman-Rock et al. 1997). "
    Recent Advances in Hip and Knee Arthroplasty, 01/2012; , ISBN: 978-953-307-841-0
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    • "E-mail address: (F. Merle-Vincent). of life [6] [7] [8]. In addition, the postoperative results were not always compared to the baseline data. "
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    ABSTRACT: To identify factors predicting patient satisfaction 2 years after total knee arthroplasty (TKA) for osteoarthritis. Prospective multicenter study of patients followed up for 2 years after TKA for osteoarthritis. We evaluated pain and function (Lequesne index and WOMAC) at baseline and after 2 years. After 2 years, the patients rated their satisfaction as a percentage, with values greater than 50% defining good satisfaction. Factors associated with good satisfaction were identified by univariate analyses followed by multivariate analysis. Of 299 patients, 264 completed the study (26 were lost to follow-up, six died, and three refused the 2-year evaluation), including 237 (89.8%) with satisfaction scores greater than 50%. Highly significant improvements were found after 2 years versus baseline in the Lequesne index (7.9 vs. 14.5, P<0.0001) and WOMAC index (26.3 vs. 51.3, P<0.0001). There were 26 (9.8%) complications. Factors significantly associated with good satisfaction in the multivariate model were absence of complications (P=0.004), body mass index less than 27 kg/m² (P=0.015), high radiological joint narrowing score (P=0.038), age greater or equal to 70 years (P=0.038), and absence of depression at the 2-year evaluation (P=0.002). We report the first prospective multicenter study done in France to assess pain and function in a large number of patients treated with TKA for osteoarthritis. Our results indicate a high success rate. We identified three factors that predict patient satisfaction and can be assessed before surgery (age greater than 70 years, absence of obesity, and severe joint space narrowing).
    Joint, bone, spine: revue du rhumatisme 12/2010; 78(4):383-6. DOI:10.1016/j.jbspin.2010.11.013 · 3.22 Impact Factor
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