Patients with Severe Radiographic Osteoarthritis Have a Better Prognosis in Physical Functioning after Hip and Knee Replacement: A Cohort-Study

J Christiaan Keurentjes,Thea P M Vliet Vlieland,Rob G Nelissen,Ron Onstenk,Cynthia So-Osman,Ruud G Pöll,Ankie W M M Koopman-Van Gemert,Marta Fiocco,Herman M Kroon,Hamid Reza Baradaran

doi:10.1371/journal.pone.0059500

J Christiaan Keurentjes, Thea P M Vliet Vlieland + Show 8 more

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https://doi.org/10.1371/journal.pone.0059500

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Abstract

IntroductionAlthough Total Hip and Knee Replacements (THR/TKR) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations. We aimed to assess whether the pre-operative radiographic severity of osteoarthritis (OA) is related to the improvement in HRQoL after THR or TKR, both at the population and individual level.MethodsIn this multi-center observational cohort study, HRQoL of OA patients requiring THR or TKR was measured 2 weeks before surgery and at 2–5 years follow-up, using the Short-Form 36 (SF36). Additionally, we measured patient satisfaction on a 11-point Numeric Rating Scale (NRSS). The radiographic severity of OA was classified according to Kellgren and Lawrence (KL) by an independent experienced musculoskeletal radiologist, blinded for the outcome. We compared the mean improvement and probability of a relevant improvement (defined as a patients change score≥Minimal Clinically Important Difference) between patients with mild OA (KL Grade 0–2) and severe OA (KL Grade 3+4), whilst adjusting for confounders.ResultsSevere OA patients improved more and had a higher probability of a relevant improvement in physical functioning after both THR and TKR. For TKR patients with severe OA, larger improvements were found in General Health, Vitality and the Physical Component Summary Scale. The mean NRSS was also higher in severe OA TKR patients.DiscussionPatients with severe OA have a better prognosis after THR and TKR than patients with mild OA. These findings might help to prevent dissatisfaction after THR and TKR by means of patient selection or expectation management.

Highlights

Total Hip and Knee Replacements (THR/Total Knee Replacement (TKR)) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations
Patients with severe radiographic OA improve more in Physical Functioning than patients with mild radiographic OA, both for Total Hip Replacement (THR) and TKR
THR and TKR patients with severe radiographic OA have a larger probability of a relevant improvement in Physical Functioning than patients with mild radiographic OA

Summary

Introduction

Total Hip and Knee Replacements (THR/TKR) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations. Total Hip Replacement (THR) and Total Knee Replacement (TKR) are effective surgical interventions, which alleviate pain and improve Health-Related Quality of Life (HRQoL) in patients with hip or knee joint degeneration at the population level. [3,4,6,11] In order to successfully manage patient expectations, accurate prediction of the probability of a meaningful improvement for each individual patient is of paramount importance. This probability can be assessed at the individual level using the Minimal Clinically Important Difference (MCID), which is defined as the minimal difference in scores of an outcome measure that is perceived by patients as beneficial or harmful. [12,13]

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