Page 43 - The value of total hip and knee arthroplasties for patients

Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis
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.
The possible association between outcomes after THA and TKA, and preoperative 3 radiographic severity has been addressed repeatedly. Nilsdotter et al.1 found that
in patients undergoing THA, the preoperative radiographic stage of osteoarthritis
(OA) was not related to the postoperative outcome after 1 year. Cushnaghan et al.2
repor ted that in TKA patients, improvement in physical function as measured with the Short Form (SF)-36 mean 7 years after surgery tended to be greater in patients with a higher Kellgren and Lawrence (KL) grade at baseline.Valdes et al.3 found that a low radiographic grade of the index joint was associated with an increased risk of postoperative pain 3 years after THA and TKA. Dowsey et al.4 reported that lower severity of radiographic OA was associated with poorer function and more pain after TKA. Keurentjes et al.5 found that both THA patients and TKA patients with severe radiographic OA had a greater improvement in the SF-36 domain “Physical functioning” than patients with mild radiographic osteoarthritis after 2–5 years of follow-up.
Although the results of most of the studies show some similarities, the designs of the studies were heterogeneous, which makes it difficult to compare them.To overcome these limitations, we determined whether the preoperative radiographic severity of OA is related to improvement in functioning, pain, and HRQoL 1 year after THA or TKA in a prospective, well-defined cohort of patients, using multivariate analysis to account for possible confounding.
Patients and methods
Patients and recruitment
This prospective cohort study was performed at the Department of Orthopaedics, Rijnland Hospital, the Netherlands from October 2010 through September 2012. We aimed to include all consecutive patients undergoing a primary THA or TKA because of OA, aged 18 years or older, who were able to read and understand Dutch and were mentally and physically capable of completing questionnaires.
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