Factors Influencing Long-Term Recovery of Total Knee Arthroplasty

C. Allyson Jones¹, Gian S. Jhangri² and Maria E. Suarez-Almazor³, ¹Departments of Physical Therapy and School of Public Health, University of Alberta, Edmonton, AB, Canada, ²School of Public Health, University of Alberta, Edmonton, AB, Canada, ³The Department of General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Epidemiologic methods, functional status, Knee, pain and total joint replacement

Session Information

Title: Orthopedics, Low Back Pain, and Rehabilitation

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Although a number of studies have examined short term outcomes after total knee arthroplasty (TKA), few have prospectively examined the long term trajectory of recovery of health-related quality of life. The aim of this study was to identify patient-related outcomes that explained the pattern of pain and functional recovery over 10 years for TKA.

Methods: This is a prospective observational study that followed a community-based cohort of patients receiving elective primary TKA within a month before surgery, 6 months, 3 years and 10 years after surgery. Data were collected from patient interviews, chart reviews and regional administrative databases. Joint pain and function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health status was evaluated over time using the SF-36. Effect sizes were calculated to measure change over time. Pre-operative and operative factors were inspected as possible variables that predicted the pattern of recovery. Linear mixed models for pain and functional recovery were used to evaluate changes over time while adjusting for covariates.

Results: Of the 289 patients followed, the mean age was 69.4 (SD 9.2) yrs;170 (59%) were female. At 10 years 145 patients responded. The mean number of comorbid conditions was 3.5 (SD 2.0) at baseline and 4.7 (SD 2.3) at 10 years. WOMAC pain score mean difference from baseline to 6 months was 33.0 (95% 30.5, 35.5) with the largest effect size (ES) of 1.89. Long-term change was much smaller from 6 months to 3 years (ES 0.18) and from 3 to10 years (ES 0.03). Smaller changes were seen with function; baseline to 6 months (ES 1.65), 6 months to 3 years (ES 0.07) and 3 to 10 years (ES -0.13). The ES of the SF-36 physical summary score at 6 months was 1.17 and over the 10 years was 1.87. After adjusting for age and gender, the 10 year trajectory for pain was explained by baseline health status (SF-36 summary scores), and baseline WOMAC pain (p< 0.05). The 10 year trajectory for function had similar covariates which explained the trajectory, in that baseline WOMAC function and health status were significant factors. In-hospital complications, prosthesis-type, and obesity did not impact long-term recovery pattern.

Conclusion: Pain and functional recovery after TKA occurs primarily within 6 months after surgery with negligible change from 3 to 10 years. Greater pain, dysfunction and lower overall health at baseline explained slower long-term recovery patterns for TKA.

Disclosure:

C. A. Jones,
None;

G. S. Jhangri,
None;

M. E. Suarez-Almazor,
None.

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