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

University of Toronto, Toronto, Ontario, Canada
Arthritis & Rheumatology (Impact Factor: 7.76). 04/2001; 42(8):1722 - 1728. DOI: 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>3.0.CO;2-R


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.
    Full-text · Article · Aug 2014
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    • "In this study we assessed the post-operative ‘state’ of our patients relative to their pre-operative ‘state’ , by including baseline pain and function scores as covariates in our regression models. While it has been reported by some that those who have worse pain and functional status pre-surgery may experience greater change in scores compared to those who have better pre-surgery status, the literature is inconsistent and a smaller change in score on a fixed ended scale in those with a better pre-surgery status may also simply reflect a ceiling effect [32,33]. Further it could be argued the actual post-operative status is more reflective of the benefit of surgery. "
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    ABSTRACT: Background We sought to determine whether socio-economic status (SES) is an independent predictor of outcome following total knee (TKR) and hip (THR) replacement in Australians. Methods In this prospective cohort study, we included patients undergoing TKR and THR in a public hospital in whom baseline and 12-month follow-up data were available. SES was determined using the Australian Bureau of Statistics ‘Index of Relative Advantage and Disadvantage’. Other independent variables included patients’ demographics, comorbidities and procedure-related variables. Outcome measures were the International Knee Society Score and Harris Hip Score pain and function subscales, and the Short Form Health Survey (SF-12) physical and mental component scores. Results Among 1,016 patients undergoing TKR and 835 patients undergoing THR, in multiple regression analysis, SES score was not independently associated with pain and functional outcomes. Female sex, older age, being a non-English speaker, higher body mass index and presence of comorbidities were associated with greater post-operative pain and poorer functional outcomes following arthroplasty. Better baseline function, physical and mental health, and lower baseline level of pain were associated with better outcomes at 12 months. In univariate analysis, for TKR, the improvement in SF-12 mental health score post arthroplasty was greater in patients of lower SES (3.8 ± 12.9 versus 1.5 ± 12.2, p = 0.008), with a statistically significant inverse association between SES score and post-operative SF-12 mental health score in linear regression analysis (coefficient−0.28, 95% CI: −0.52 to −0.04, p = 0.02). Conclusions When adjustments are made for other covariates, SES is not an independent predictor of pain and functional outcome following large joint arthroplasty in Australian patients. However, relative to baseline, patients in lower socioeconomic groups are likely to have greater mental health benefits with TKR than more privileged patients. Large joint arthroplasty should be made accessible to patients of all SES.
    Full-text · Article · May 2014 · BMC Musculoskeletal Disorders
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    • "While other studies showed that patients preoperative function predicted outcome and satisfaction [35-37], the preoperative Womac score was not selected in our regression models. This could be explained by the adjustment on surgeons’ expectations in our study; surgeons rated their expectations according to preoperative function, as previously discussed. "
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    ABSTRACT: Between 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA). Before THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed. Preoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient's expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient -0.55 [-0.88; -0.21], p = 0.002), good physical function (-0.96 [-1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (-2.10 [-2.79; -1.42], p <0.001) and pain relief (-14.83 [-22.38; -7.29], p < 0.001). To improve patient satisfaction after THA, patients' expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons' expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons' and patients' expectations.
    Full-text · Article · Feb 2014 · BMC Musculoskeletal Disorders
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