Background/Purpose: Knee and hip osteoarthritis (OA) are the clinical outcome of a functional and structural failure resulting with pain and physical dysfunction. Total joint arthroplasty is increasingly utilised surgical treatment at the end stage (OA). The ultimate goal of arthroplasty surgery is for the patient to be able to forget the artificial joint during daily activities. The traditional main outcomes are clinically objective surgeon-reported endpoints. Patient-reported outcome assessment is the primary indicator of patient satisfaction with their operated joint results. The aim of this study is to investigate long-term patient functional outcomes and relationship with the ability to forget their artificial joint according to patients’ perspective.

Methods: Consecutive 72 patients undergone unilateral cemented total hip arthroplasty or total knee arthroplasty (THA; n=42; TKA; n=30) for primary OA in Hacettepe University Hospital between January 2010 and January 2014, participated in the study. Patients were asked to complete the patient-reported outcome (PRO) assessments such as the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, Tampa Kinesiophobia Scale (TKS) and the Forgotten Joint Score (FJS-12). WOMAC Index was used to assess pain, stiffness and function. The TKS assessed the fear of movement. The FJS-12 consists of 12 questions where subjects were asked to rate their awareness of their joint arthroplasty during various activities.

Results: Average age ­­­­61.9 ± 14.6 years; 82% female, 50% obese (BMI>=30kg/m²). Average time after surgery was 30.8±16.1 months. Mean post-operative WOMAC pain score was 13±3.2, WOMAC stiffness score was 7±1.4, WOMAC function score was 48±18.4. Mean TSK was 43.0±8.7 and mean FJS-12 score was 66.1±21.5. Correlations between FJS-12 and WOMAC and TKS scores were as follows: r=-0.68 for WOMAC-Pain, r=-0.53 for WOMAC-Stiffness, r=-0.65 for WOMAC-Function, and r=-0.63 for TKS in patients with TKA. Correlations between FJS-12 and WOMAC function score and TKS scores were as follows: r=-0.58 and r=-0.62 in patients with THA.

Conclusion: Assessing patients’ perception about their artificial joint is becoming more important in clinical area following total joint arthroplasty. The true success of the surgery may not equate to the sum of a set outcome variables. Long-term follow-up with PROs showed that there is a need for a greater focus on understanding the perspectives of patients following arthroplasty surgery to improve the efficacy of interventions focused on better functional outcomes in TKA and THA recipients.

References:

1)Bolink SA, Grimm B, Heyligers IC. Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty. Knee. 2015 May 29.

2)Behrend H, Giesinger K, Giesinger JM, Kuster MS. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure.J Arthroplasty. 2012 Mar;27(3):430-436.

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