Page 181 - The value of total hip and knee arthroplasties for patients

2. The role of radiographic abnormalities as a predictor of recovery after THA and TKA
Chapter 3 describes the impact of radiographic severity of hip and knee OA on improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA.
It concerned a prospective cohort study including 302 THA patients and 271 TKA patients. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and PROMs: SF36, EQ5D, H/KOOS, and the OHS/OKS) OHS/OKS. In addition, age, sex, Body Mass Index (BMI) and comorbidity (Charnley score) were recorded. Change scores of PROMs were compared between patients with with mild OA (KL 0-2) and severe OA (KL 3-4) using a multivariate linear regression model.
In the THA patients 77 (26%) had mild OA and 225 (74%) had severe OA preoperatively; in the TKA patients, 74 (27%) had mild OA and 197 (73%) had severe OA. Adjusted for sex, age, BMI, Charnley score and preoperative clinical scores, radiographic severity of OA was statistically significantly associated with improvement in the HOOS subscales “Activities of daily living”, “Pain”, and “Symptoms”, and the SF36 physical component summary (“PCS”) scale in THA patients.InTKA,no statistically significant associations were seen.Given these findings, it was concluded that 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.
3. The fulfilment of patients’ preoperative expectations regarding recovery to normal activities and the process of returning to work after THA or TKA Chapter 4 describes patients’ preoperative expectations of outcomes of THA or TKA regarding specific aspects of functioning and determined to what extent each
expectation was fulfilled after 1 year.
Within a the same cohort study as described in Chapter 3,preoperative expectations and their fulfilment after 1 year were measured with the Hospital for Special Surgery Hip/Knee arthroplasty Expectations Surveys. Preoperative and postoperative scores were subtracted to calculate whether expectations were unfulfilled, fulfilled, or exceeded.
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