Elsevier

The Journal of Arthroplasty

Volume 24, Issue 7, October 2009, Pages 1033-1043
The Journal of Arthroplasty

Is Postoperative Function After Hip or Knee Arthroplasty Influenced by Preoperative Functional Levels?

https://doi.org/10.1016/j.arth.2008.09.010Get rights and content

Abstract

Our objective was to evaluate functional outcomes after surgery in a subgroup of patients presenting for hip and knee surgery who had low functional scores before surgery. One hundred twenty-seven unilateral total hip and knee arthroplasty patients were assessed preoperatively and 3 consecutive years after arthroplasty using: Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short Form 36 (SF-36), and the Quality of Well-Being index scales. Patients were placed into 2 groups based on preoperative WOMAC function scores; 51 points or more, worse functioning group, and less than 51 points, higher functioning group. Regardless of time, the worse functioning group in both procedures performed worse on the Quality of Well-Being index, SF-36 (function score), SF-36 (social score), and WOMAC total and pain scores (P ≤ .0001). The greatest change (range, 2%-638%) for all variables in both groups for both procedures occurred during the first year. Patients that had severe/extreme functional impairment had worse 3-year outcomes compared with patients getting surgery when their functional levels were better.

Section snippets

Patient Selection

Primary hip or knee arthroplasty patients with available preoperative, 1, 2, and 3 year postoperative evaluations were selected from a joint registry maintained by the senior author (N = 127) over a 5-year period. All patients gave written consent, which was approved by the institutional review board at Mercy Hospital. Inclusion criteria were those individuals having primary unilateral joint arthroplasty secondary to knee or hip joint osteoarthritis. Exclusion criteria were those individuals

Hip

Twenty-four individuals had preoperative WOMAC physical function dimension scores of 51 or greater and made up the WF group (n = 24). The average age of this group was 59.67 ± 16.22 years; there were 12 women and 12 men. The average age of the HF group (n = 38) was 61.11 ± 16.23 years; 16 were women and 22 were men. Diagnoses for hip arthroplasty by group is presented in Table 1. Range of motion and frequency of assistive device usage before and after surgery, for both WF and HF groups, are

Discussion

Optimal timing of arthroplasty surgery will have an impact on costs as well as on outcomes. For example, poor preoperative functional status in patients with rheumatoid arthritis who are undergoing total hip or knee arthroplasty is predictive of longer hospital length of stay [6]. Escalante and Beardmore [6] also demonstrated that surgery performed before failure of conservative treatments may decrease length of hospital stay and minimize postsurgical loss of function. More recently, Fortin et

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Conflict of interest statement: Financial support has been received by the corresponding author: Mercy Hospital, Miami, FL; Zimmer, Inc, Warsaw, IN; and Arthritis Surgery Research Foundation, Inc, Miami, FL. Royalties: Zimmer, Inc. Consultant: Zimmer, Inc.

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