Why Doesn’t Participation in Activity Increase Following Hip or Knee Replacement?

Aileen Davis¹, Viji Venkataramanan¹, Jessica Bytautas², Rose Wong¹, Lisa Carlesso¹, Anthony Perruccio³ and Fiona Webster², ¹Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada, ²Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada, ³Toronto Western Hospital, University Health Network, Toronto, ON, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Hip, Knee, Participation and pain

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ARHP): Clinical Practice/Patient Care

Session Type: Abstract Submissions (ARHP)

Background/Purpose

Activity is critical for healthy aging. Our prior work demonstrated that despite improved pain and function, people did not increase their participation in activity post total hip or knee replacement (TJR). Our subsequent qualitative work identified that not only had people given up many activities prior to TJR, they experienced new comorbidity or symptomatic joints that limited their engagement. They also described significant life changes that impacted participation. This study evaluated if these health and social contextual factors were associated with change in participation.

Methods

We conducted a retrospective analysis of our TJR cohort. The primary outcome was change in participation frequency (Late Life Disability Index (LLDI) frequency subscale) pre- to 1 year post-surgery. Predictors were: surgical complication, new comorbidity, another primary TJR, and positive and negative life events (Life Experience Survey) in the year following TJR. Analyses included multivariable regression for the TKR and THR cohorts, adjusting for age, sex, education, pre-surgery BMI, comorbidity, and frequency, and change pre- to 1 year post-TJR in depression, WOMAC pain and function and LLDI limitations.

Results

The 418 TKR patients (mean age=65, 36% male, 69% >high school education) had a mean BMI of 30 and 49%, 6%, 13%, 12% had hypertension, CVD, diabetes, lung disease respectively. 74 episodes of new comorbidity (29 hypertension, 27 CVD, 8 diabetes, 10 lung disease) occurred. 38 (12%) had a complication, 39 another TJR, 151 (36%) reported a positive life event and 273 (65%) a negative life event. In adjusted analyses, pre-operative frequency, having a complication and negative life events were associated with less change in frequency.

The 376 THR patients (mean age=64, 46% male, 77% >high school education) had a mean BMI of 28 pre-surgery. 157 (42%) had hypertension, 28 (7%) had CVD, 31 (8%) had diabetes and 19 (5%) had lung disease. 34 (9%) had a complication and 33 (9%) another TJR. 54 episodes of a new comorbidity were reported (19 hypertension, 19 CVD, 4 diabetes, 12 lung disease). In adjusted analysis, lower pre-surgery frequency was associated with less change and positive life events were associated with greater change in frequency.

Conclusion

Low activity pre-TJR coupled with social context influenced changes in engagement in activity post TJR. Although additional health issues occurred, other than complications of TKR, none were associated with change in frequency. To promote healthy aging in people having TJR, appropriate timing of surgery, pre-surgical interventions to maintain activity and targeted programs post-surgery considering social context are required to enhance activity.

Disclosure:

A. Davis,
None;

V. Venkataramanan,
None;

J. Bytautas,
None;

R. Wong,
None;

L. Carlesso,
None;

A. Perruccio,
None;

F. Webster,
None.

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