Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Studies evaluating patient-reported long term outcomes (>10 years) after primary TKA are lacking. Moreover, variability in patient satisfaction after TKA has been reported for the short and mid term, but has not been investigated over the long term and in relation to presence or absence of neuropathic pain.
Our objective was to assess pain, function, general health, and patient satisfaction at short, mid and long term following primary TKA.
Methods
Patients eligible for this study were part of a prospective hospital-based cohort of all primary TKAs operated upon since March 1998. All patients operated in 2012, 2010, 2007, and 2004-1998, who were alive and still living in the area, received a postoperative questionnaire by mail between 2012 and 2013. We performed repeat cross-sectional analyses of pain, function, general health and patient satisfaction at the following time-points: prior to surgery, and 1, 2, 5, 9-11 and 12-15 years postoperative. Pain was evaluated with use of WOMAC and VAS score, neuropathic pain with DN4 (=neuropathic pain diagnostic questionnaire), function with WOMAC, general health with the SF-12, and satisfaction was evaluated with use of a five-item satisfaction rating.
Results
1451 TKAs were eligible (68.4% women, mean age 71 (±9) years, mean BMI 29.6 kg/m²). Of those, 1021 returned the questionnaire (response rate 70.4%). Their mean age was 71 years, mean BMI was 29.5 kg/m² and 67.8% were women. Mean values of pain, function and general health were clinically significantly higher (effect sizes 0.22-1.71) one year postoperative as compared to prior to surgery (see Table). For pain and satisfaction there was an ongoing clinically significant “improvement” between 1 and 2 years postoperative. Results remained similar between 2 and 10 years with minimally lower (effect size <0.2) outcomes between 10 and 15 years. Neuropathic pain was reported in 12.4% preoperative, 14% at 1 year, 10% at 2 years and 5-7% 5-15 years after surgery. Its presence was significantly (p<0.001) associated with dissatisfaction.
Conclusion
Clinical outcomes and patient satisfaction were similar between 2 and 15 years after primary TKA. Neuropathic pain when present was strongly associated with dissatisfaction.
|
|
Prior to surgery |
n |
1 yr. post surgery |
n |
2 yrs. post surgery |
n |
5 yrs. post surgery |
n |
10 yrs. post surgery |
n |
12-15 yrs. post surgery |
n |
|
WOMAC, mean, SD |
|
|
|
|
|
|
|
|
|
|
|
|
|
Pain |
39.8 (±17.9) |
785 |
72.2 (±22.1) |
529 |
77.9 (±22.0) |
111 |
82.3 (22.6) |
100 |
78.8 (±23.6) |
145 |
75.5 (±26.4) |
136 |
|
Function |
43.7 (±19.3) |
769 |
70.1 (±21.8) |
526 |
68.1 (±22.7) |
107 |
69.1 (±25.0) |
102 |
69.8 (±26.4) |
144 |
67.2 (±28.8) |
136 |
|
VAS pain, mean, SD |
5.9 (±1.8) |
389 |
2.4 (±2.2) |
522 |
2.0 (±2.3) |
106 |
1.6 (2.4) |
103 |
2.0 (±2.5) |
138 |
2.0 (±2.5) |
140 |
|
SF-12, mean, SD |
|
|
|
|
|
|
|
|
|
|
|
|
|
pcs |
34.3 (±7.6) |
777 |
40.4 (±8.8) |
521 |
40.2 (±9.8) |
106 |
39.8 (±10.5) |
98 |
38.9 (±10.0) |
136 |
37.5 (±9.9) |
126 |
|
mcs |
44.9 (±11.2) |
777 |
47.3 (±11.0) |
521 |
47.9 (±10.3) |
106 |
46.9 (±9.9) |
98 |
47.5 (±11.2) |
136 |
45.9 (±10.0) |
126 |
|
DN4 score ≥ 4 (%)* |
14 (12.4) |
113 |
27 (14.4) |
187 |
11 (10.3) |
107 |
7 (6.9) |
102 |
8 (5.8) |
138 |
7 (5.1) |
136 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Satisfaction (%) |
|
|
|
520 |
|
109 |
|
103 |
|
151 |
|
142 |
|
Very satisfied |
|
|
252 (48.5) |
|
54 (49.5) |
|
48 (46.6) |
|
90 (59.6) |
|
81 (57.0) |
|
|
Satisfied |
|
|
157 (30.2) |
|
39 (35.8) |
|
39 (37.9) |
|
42 (27.8) |
|
37 (26.1) |
|
|
Somewhat satisfied |
|
|
73 (14.0) |
|
10 (9.2) |
|
8 (7.8) |
|
10 (6.6) |
|
10 (7.0) |
|
|
Somewhat dissatisfied |
|
|
15 (2.9) |
|
2 (1.8) |
|
4 (3.9) |
|
2 (1.3) |
|
5 (3.5) |
|
|
Dissatisfied |
|
|
23 (4.4) |
|
4 (3.7) |
|
4 (3.9) |
|
7 (4.6) |
|
9 (6.3) |
|
|
DN4 score ≥ 4 in Dissatisfied (%)** |
|
|
46.2 % |
|
66.7% |
|
|
|
17.9%*** |
|
|
|
*DN4 score = neuropathic pain diagnostic questionnaire; **among dissatisfied and somewhat dissatisfied patients taken together; ***5-15 years after surgery combined
Disclosure:
A. Lübbeke,
None;
M. Zingg,
None;
D. Fritschy,
None;
P. Hoffmeyer,
None,
9;
H. Miozzari,
None.
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