Article

The Effects of Total Knee Arthroplasty on Physical Functioning in the Older Population

Duke University, Durham, North Carolina 27708-0088, USA.
Arthritis & Rheumatology (Impact Factor: 7.87). 10/2008; 58(10):3166-71. DOI: 10.1002/art.23888
Source: PubMed

ABSTRACT Clinical research provides convincing evidence that total knee arthroplasty (TKA) is safe and improves joint-specific outcomes. However, higher-level functioning associated with self care and independent living has not been studied. Furthermore, most previous studies of the effects of TKA relied on relatively small clinical samples. We undertook this study to estimate the effects of TKA on 3 levels of physical functioning in a national sample of older adults.
Data were obtained from the Medicare Current Beneficiary Survey from 1992 to 2003. Medicare claims data identified participants with osteoarthritis of the knee who received TKA (n=259) or no TKA (n=1,816). Propensity scores were used to match treatment and no-treatment groups according to demographic characteristics, comorbid conditions, and baseline functioning. Three levels of physical functioning were examined as outcomes of TKA. These levels were represented by items on the Nagi Disability Scale, the Instrumental Activities of Daily Living (IADL) Scale, and the Activities of Daily Living (ADL) Scale. These items were measured after TKA and at comparable intervals for the no-treatment group. Average treatment effects were calculated for relevant Nagi Disability Scale, IADL Scale, and ADL Scale tasks.
Between baseline and outcome assessments, TKA recipients improved on all 3 levels of physical functioning; the no-treatment group declined. Statistically significant average treatment effects for TKA were observed for one or more tasks for each measure of physical functioning.
TKA is associated with sizeable improvements in 3 levels of physical functioning among elderly Medicare beneficiaries.

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    ABSTRACT: Objectives This study examined the effects of total knee arthroplasty on six measures of physical functioning, self-rated health, pain, earnings, and employment status among US adults aged 51 to 63 years at baseline. Methods Data came from the Health and Retirement Study, a nationally representative longitudinal study conducted biannually. The analysis sample consisted of individuals aged 51 to 63 years at baseline with arthritis who were resurveyed at 2-year intervals from 1996 to 2010. Propensity score matching was used to compare outcomes of persons receiving total knee arthroplasty (TKA) with those of matched controls. Six measures of physical functioning were examined: lower-body mobility problems, instrumental activities of daily living limitations, activities of daily living limitations, and large muscle, fine motor, and gross motor limitations. Self-rated health and pain were also examined. The two employment-related outcomes were earnings and employment status. Results Receipt of TKA was associated with better outcomes for several measures of physical functioning, especially mobility limitations, pain, and self-rated health. Receipt of TKA was not associated with increased earnings or employment. Conclusions Receipt of TKA yields important improvements in physical function among persons with an arthritis diagnosis who received the procedure before reaching the age of 65 years. This study contributes to knowledge about the benefits of TKA in a community setting among nonelderly recipients of TKA.
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