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Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients.

Tilbury C, Holtslag MJ, Tordoir RL, Leichtenberg CS, Verdegaal SH, Kroon HM, Fiocco M, Nelissen RG, Vliet Vlieland TP - Acta Orthop (2015)

Bottom Line: Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.In TKA, we found no such associations.The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedics , Leiden University Medical Center , Leiden , the Netherlands.

ABSTRACT

Background and purpose: There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA.

Patients and methods: This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.

Results: Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS "Activities of daily living", "Pain", and "Symptoms", and SF36 physical component summary ("PCS") scale. In TKA, we found no such associations.

Interpretation: The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

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Flow diagram. aReasons for exclusion were patients who did not understand Dutch or were physically or mentally unable to complete questionnaires, patients with revision surgery, undergoing a hemi-arthroplasty, or undergoing THA or TKA because of a tumor or rheumatoid arthritis.
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Figure 0001: Flow diagram. aReasons for exclusion were patients who did not understand Dutch or were physically or mentally unable to complete questionnaires, patients with revision surgery, undergoing a hemi-arthroplasty, or undergoing THA or TKA because of a tumor or rheumatoid arthritis.

Mentions: 745 patients were admitted for THA and 614 patients were admitted for TKA from October 2010 through September 2012. Primary THA for primary OA was performed in 665 patients. Primary TKA for primary OA was performed in 599 patients. These 1,264 patients met all of the selection criteria and were asked to complete a questionnaire 1 day preoperatively. Of these, 302 THA and 271 TKA patients were included in the present study (Figure 1).Figure 1.


Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients.

Tilbury C, Holtslag MJ, Tordoir RL, Leichtenberg CS, Verdegaal SH, Kroon HM, Fiocco M, Nelissen RG, Vliet Vlieland TP - Acta Orthop (2015)

Flow diagram. aReasons for exclusion were patients who did not understand Dutch or were physically or mentally unable to complete questionnaires, patients with revision surgery, undergoing a hemi-arthroplasty, or undergoing THA or TKA because of a tumor or rheumatoid arthritis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940595&req=5

Figure 0001: Flow diagram. aReasons for exclusion were patients who did not understand Dutch or were physically or mentally unable to complete questionnaires, patients with revision surgery, undergoing a hemi-arthroplasty, or undergoing THA or TKA because of a tumor or rheumatoid arthritis.
Mentions: 745 patients were admitted for THA and 614 patients were admitted for TKA from October 2010 through September 2012. Primary THA for primary OA was performed in 665 patients. Primary TKA for primary OA was performed in 599 patients. These 1,264 patients met all of the selection criteria and were asked to complete a questionnaire 1 day preoperatively. Of these, 302 THA and 271 TKA patients were included in the present study (Figure 1).Figure 1.

Bottom Line: Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.In TKA, we found no such associations.The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedics , Leiden University Medical Center , Leiden , the Netherlands.

ABSTRACT

Background and purpose: There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA.

Patients and methods: This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.

Results: Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS "Activities of daily living", "Pain", and "Symptoms", and SF36 physical component summary ("PCS") scale. In TKA, we found no such associations.

Interpretation: The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

Show MeSH
Related in: MedlinePlus