Session Type: Abstract Submissions (ACR)
Few have examined the trajectories of preoperative health-related quality of life (HRQL) measures in osteoarthritis (OA) patients who undergo TKR. Yet, the type and rate of preoperative decline may predict the outcomes of TKR. The objectives of the study are to determine whether changes in preoperative HRQL measures are associated with improvement after TKR and to identify important predictors of clinically significant improvement.
Data from people who underwent TKR were obtained from the Osteoarthritis Initiative (OAI), a study which annually assessed participants. T0 was the assessment prior to TKR while T-1 was the assessment prior to that. T+2 was the second assessment after TKR. We compiled data on OA-related symptoms (i.e. pain/aching/stiffness most days of the month in the last year), the WOMAC, activities, and radiographic severity (i.e. Kellgren-Lawrence grade, KLG). We defined clinically significant improvement as improvement in WOMAC total score ≥ to the minimal important difference (0.5 standard deviation of mean change in the study data) between T0 and T+2. After conducting bivariate tests for differences, logistic regression models were performed to evaluate the relationship between improvement and preoperative measures. Only variables associated with improvement at p ≤ 0.2 in a series of stepwise regressions were included.
Our sample consists of 211 improved & 58 unimproved patients. Improved, compared to unimproved, patients had higher preoperative (T0) WOMAC pain (39.31 ± 17.86 vs. 22.73 ± 17.92, p<0.001), disability (39.17 ± 15.08 vs. 18.23 ± 16.86, p<0.001) and stiffness (46.45 ± 20.21 vs. 27.37 ± 20.47, p<0.001) scores in the index knee (i.e. TKR knee). Those who had improvement were more likely to report OA-related symptoms in the index knee (96.68% vs. 77.59%, p<0.001). They also had greater worsening of their WOMAC pain (9.65 ± 19.53 vs. 2.48 ± 13.19, p=0.002), disability (9.87 ± 17.22 vs. -0.16 ± 13.38, p<0.001) and stiffness (9.11 ± 23.23 vs. -0.24 ± 20.34, p=0.009) scores from T-1 to T0 in the index knee.
Preoperative measures as predictors of improvement in our multivariate model included: Higher WOMAC disability (OR 1.09, 95% CI [1.05-1.13], p<0.001), presence of OA-related symptoms in the index (OR 7.13, 95% CI [1.77-28.67], p=0.006) but absence in the contralateral (OR 8.07, 95% CI [2.75-23.74], p<0.001) knee, exposure to frequent knee bending (OR 3.01, 95% CI [1.02-8.87], p=0.045), having a KLG of 4 (vs. 0, 1, 2 or 3) in the contralateral (OR 4.40, 95% CI [1.24-15.56], p=0.022) and index (p=0.124) knee, and worse SF-12 Mental Health score (p=0.209).
More than 75% of OAI patients had clinically significant improvement after TKR. Improved patients had more self-reported pain and disability prior to surgery and were more likely to have escalation of these symptoms than unimproved patients. Worse OA-related disability prior to surgery, presence of OA symptoms in the surgical knee, prior exposure to frequent knee bending, and having marked radiographic features of OA but without OA-related symptoms in the contralateral knee all increase the likelihood of achieving clinically significant improvement after TKR.
E. R. Vina,
M. J. Hannon,
C. K. Kwoh,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-following-total-knee-replacement-tkr-surgery-exploring-preoperative-symptoms-and-change-in-preoperative-symptoms/