243 VETERANS WITH TOTAL KNEE ARTHRPLASTY (TKA) AND TOTAL HIP ARTHROPLASTY (THA) HAVE SIGNIFICANT FUNCTIONAL LIMITATION AND INCREASED HEALTH CARE UTILIZATION: A POPULATION BASED STUDY

Abstract

243 – Table 1. Functional ADL limitation and Health Care Utilization % with dificulty in each ADL OR mean (± standard deviation)/ Control Primary Primary Combination p-value proportion with inor out-patient visits population TKA THA Group Bathing 40% 44% 53% 57% <0.0001 Dressing 32% 35% 55% 48% <0.0001 Eating 52% 72% 71% 75% <0.0001 Transferring from chair 72% 82% 85% 89% <0.0001 Walking 21% 23% 33% 31% 0.0009 #Primary Care Stops 3.1±0.02 3.3±0.2 3±0.2 3.3±0.2 0.2829 #Surgery Stops 2±0.02 2.5±0.2 2.3±0.2 2.3±0.2 0.0102 ≥ mental health stop 18% 12% 11% 12% 0.0037 ≥ inpatient visit 16% 24% 19% 26% <0.0001 After multivariable-adjustment, significantly more veterans with THA or TKA than controls had limitation in all ADLS except eating and ≥1 inpatient admissions/year. Veterans with TKA/TKA had significantly higher annual outpatient surgery stops, but similar primary care and medical subspecialty stops. Significantly lower proportion had ≥1 mental health visits/year as (see Table 1). Conclusions: Poorer function in veterans with TKA/THA, even after controlling for other differences, may be due to more severe contralateral hip/knee arthritis, more severe medical comorbidity or to unmeasured comorbidity (renal failure, alcohol use, metabolic syndrome etc.). Higher surgery clinic utilization may be due to higher orthopedics clinic utilization and/or to more severe medical comorbidities leading to more surgical procedures; higher inpatient utilization to more severe comorbidity. Further studies should investigate whether severity of arthritis and comorbidity are associated with these outcomes, and whether better comorbidity management can improve functional status and decrease utilization.