A Prospective, Longitudinal Study of Patient Satisfaction Following Total Knee Arthroplasty Using the Short-Form 36 (SF-36) Survey Stratified by Various Demographic and Comorbid Factors

Background:Total Knee Arthroplasty (TKA)1is a common surgical treatment for severe knee Osteoarthritis (OA)2, which generally improves pain, physical function, quality of life and possibly fall risk. Fall risk increases for older adults with severe knee OA; however it has not been studied extensively whether this parameter is improved after TKA.Objective:To investigate: a) the history and frequency of falls, including mechanism or causes of falls, injuries sustained from falls reported, activity during falling and location of falls and, b) the factors affecting falls, a year after TKA in elderly patients with severe knee OA.Patients and Method:An observational prospective longitudinal study of 68 patients (11 males and 57 females) was conducted. The frequency of falls was recorded every month after knee replacement for a year period. A year after the TKA patients completed self-administered questionnaires (SF-36, Womac, FOF, ABC, PASE) and were assessed in physical performance tests (TUG and BBS).Results:There was significant improvement in falls frequency (p<0.001), differentiation of falling status to the benefit of non fallers (p<0.001) and risk of serious injuries (p<0.001). The factors that affected falling status was history of falls (p<0.0005), fear of falls (p<0.017) and advanced age, marginally (p<0.097).Conclusion:TKA generally improved a lot of aspects in patients’ life. One of these was the reduction of fall risk, which always co-exists in this population and can cause devastating problems threatening the benefits of the procedure.

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Early Postoperative Measures Predict 1- and 2-Year Outcomes After Unilateral Total Knee Arthroplasty: Importance of Contralateral Limb Strength

Physical Therapy ◽

10.2522/ptj.20090089 ◽

2010 ◽

Vol 90 (1) ◽

pp. 43-54 ◽

Cited By ~ 62

Author(s):

Joseph A. Zeni ◽

Lynn Snyder-Mackler

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Repeated Measures ◽

Quadriceps Muscle ◽

Stair Climbing ◽

Prospective Longitudinal Study ◽

Age Related ◽

Functional Scores ◽

Total Knee ◽

Prospective Longitudinal

Background Total knee arthroplasty (TKA) has been shown to be an effective surgical intervention for people with end-stage knee osteoarthritis. However, recovery of function is variable, and not all people have successful outcomes. Objective The aim of this study was to discern which early postoperative functional measures could predict functional ability at 1 year and 2 years after surgery. Design and Methods One hundred fifty-five people who underwent unilateral TKA participated in the prospective longitudinal study. Functional evaluations were performed at the initial outpatient physical therapy appointment and at 1 and 2 years after surgery. Evaluations consisted of measurements of height, weight, quadriceps muscle strength (force-generating capacity), and knee range of motion; the Timed “Up & Go” Test (TUG); the stair-climbing task (SCT); and the Knee Outcome Survey (KOS) questionnaire. The ability to predict 1- and 2-year outcomes on the basis of early postoperative measures was analyzed with a hierarchical regression. Differences in functional scores were evaluated with a repeated-measures analysis of variance. Results The TUG, SCT, and KOS scores at 1 and 2 years showed significant improvements over the scores at the initial evaluation (P<.001). A weaker quadriceps muscle in the limb that did not undergo surgery (“nonoperated limb”) was related to poorer 1- and 2-year outcomes even after the influence of the other early postoperative measures was accounted for in the regression. Older participants with higher body masses also had poorer outcomes at 1 and 2 years. Postoperative measures were better predictors of TUG and SCT times than of KOS scores. Conclusions Rehabilitation regimens after TKA should include exercises to improve the strength of the nonoperated limb as well as to treat the deficits imposed by the surgery. Emphasis on treating age-related impairments and reducing body mass also might improve long-term outcomes.

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Exercise Combined With Continuous Passive Motion or Slider Board Therapy Compared With Exercise Only: A Randomized Controlled Trial of Patients Following Total Knee Arthroplasty

Physical Therapy ◽

10.1093/ptj/81.4.1029 ◽

2001 ◽

Vol 81 (4) ◽

pp. 1029-1037 ◽

Cited By ~ 78

Author(s):

Lauren A Beaupré ◽

Donna M Davies ◽

C Allyson Jones ◽

John G Cinats

Keyword(s):

Total Knee Arthroplasty ◽

Randomized Controlled Trial ◽

Knee Arthroplasty ◽

Short Form ◽

Controlled Trial ◽

Continuous Passive Motion ◽

Passive Motion ◽

Randomized Controlled ◽

Sf 36 ◽

Total Knee

Abstract Background and Purpose. The primary purpose of this randomized controlled trial was to determine which method of mobilization—(1) standardized exercises (SE) and continuous passive motion (CPM), (2) SE and slider board (SB) therapy, using an inexpensive, nontechnical device that requires minimal knee active range of motion (ROM), or (3) SE alone—achieved the maximum degree of knee ROM in the first 6 months following primary total knee arthroplasty (TKA). The secondary purpose was to compare health-related quality of life among these 3 groups. Subjects. The subjects were 120 patients (n=40/group) who received a TKA at a teaching hospital between June 1997 and July 1998 and who agreed to participate in the study. Methods. Subjects were examined preoperatively, at discharge, and at 3 and 6 months after surgery. The examination consisted of measurement of knee ROM and completion of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results. The 3 treatment groups were similar with respect to age, sex, and diagnosis at the start of the study. There were no differences in knee ROM or in WOMAC Osteoarthritis Index or SF-36 scores at any of the measurement intervals. The rate of postoperative complications also was not different among the groups. Discussion and Conclusion. When postoperative rehabilitation regimens that focus on early mobilization of the patient are used, adjunct ROM therapies (CPM and SB) that are added to daily SE sessions are not required. Six months after TKA, patients attain a satisfactory level of knee ROM and function.

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Depression Is Not Independently Associated with a Clinically Worse Functional Improvement but Associated with a Lower Reported Satisfaction Rate after Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1716669 ◽

2020 ◽

Author(s):

Nicholas D. Clement ◽

Chung M. A. Lin ◽

Emma McCone ◽

David J. Weir ◽

David J. Deehan

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Retrospective Cohort ◽

Short Form ◽

Functional Improvement ◽

Level Of Evidence ◽

Significant Difference ◽

Total Knee ◽

Clinically Significant

AbstractThe aim of this study was to assess whether depression had a clinically significant influence on the functional improvement of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and whether it influences patient satisfaction at 1 year. A retrospective cohort of 3,510 primary TKA was identified from an arthroplasty database. Patient demographics, comorbidities, WOMAC, and Short Form-12 (SF-12) scores were collected preoperatively and 1 year postoperatively. Patient satisfaction (overall, pain relief, return to work, and recreational activity) was assessed at 1 year. There were 444 (12.6%) patients who self-reported depression. Patients with depression were younger (p < 0.001), had a higher body mass index (BMI; p < 0.001), were more likely to be female (p < 0.001), had lung (p < 0.001), neurological (p = 0.018), kidney (p = 0.001), liver (p < 0.001), and gastric (p < 0.001) disease, report associated diabetes (p = 0.001), and back pain (p < 0.001) relative to the subgroup without depression. All preoperative WOMAC functional measures were significantly (p < 0.001) worse in patients with reported depression. When adjusting for these confounding differences, patients with depression had a clinically equal improvement in their WOMAC scores at 1 year compared to those patients without. Depression was not associated with a clinically significant difference in improvement of knee-specific outcome (WOMAC) but was independently associated with a lower rate of patient satisfaction 1 year after TKA. Patients with depression were approximately twice as likely to be dissatisfied at 1 year when compared with those without depression. This is a prognostic retrospective cohort study and reflects level of evidence III.

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Expectations of Singaporean patients concerning activities after total knee arthroplasty

Proceedings of Singapore Healthcare ◽

10.1177/2010105818815514 ◽

2018 ◽

Vol 28 (3) ◽

pp. 153-158

Author(s):

Benjamin Tze Keong Ding ◽

Sathappan S Sathappan

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Short Form ◽

Multivariate Regression Analysis ◽

Medical Outcomes ◽

Level Of Evidence ◽

Replacement Surgery ◽

Sf 36 ◽

Total Knee

Background: There are many factors that affect the experience and satisfaction of a patient undergoing knee replacement surgery. Objective: This study aims to explore the effects of demographic factors, disease severity and several novel parameters on patients’ expectations in a Singaporean population. Methods: Phone interviews were conducted with 69 patients to measure their expectations before total knee arthroplasty (TKA). Information such as demographics, surgical histories, baseline Medical Outcomes Study Short Form 36 (SF-36) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS), kneeling ability, quality of reviews from relatives or friends and histories of any traditional therapies utilised were obtained. Radiological severity of osteoarthritis was graded using the Kellgren–Lawrence scale; discordance with severity of knee pain was recorded. Results: Patients expected TKA to result in pain relief, improved mobility, increased ability to participate in physical activities, and paid employment. On multivariate regression analysis, LEAS, SF-36 physical, KOOS-pain and KOOS-activity of daily living scores remained significant predictors of expectations. Conclusion: The results indicated multiple factors influence patient’s expectations pre-operatively and their satisfaction post-operatively. Better patient outcomes may be achieved by making improvements in understanding and moderating patient expectations. Level of evidence: Diagnostic III

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Risk Factors for Fear of Falling in Elderly Patients with Severe Knee Osteoarthritis before and One Year after Total Knee Arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/1602400306 ◽

2016 ◽

Vol 24 (3) ◽

pp. 302-306 ◽

Cited By ~ 8

Author(s):

Theano Tsonga ◽

Maria Michalopoulou ◽

Stylianos Kapetanakis ◽

Eirini Giovannopoulou ◽

Paraskevi Malliou ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Fear Of Falling ◽

Short Form ◽

Timed Up And Go ◽

Sf 36 ◽

Total Knee ◽

One Year

Purpose To evaluate the regression of fear of falling (FOF) and identify its risk factors in patients with severe knee osteoarthritis before and one year after total knee arthroplasty (TKA). Methods 11 men and 57 women with a mean age of 73 years and a mean body mass index of 30.36 kg/m2 who had severe (grade 3 or 4) knee osteoarthritis and knee pain of ≥1 year were included. Two weeks before and one year after TKA, patients were asked about their FOF status and falls history. Patients were asked to complete the Physical Activity Scale for the Elderly, Short Form 36 (SF-36), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaires. Clinical performance was assessed using the Berg Balance Scale and Timed Up and Go (TUG) test. Results Of the 68 patients, 56 (82.4%) had FOF preoperatively and 30 (44.1%) had FOF one year after TKA (p<0.001). The strongest predictors for FOF preoperatively were fallers (odds ratio [OR]=9.83, p=0.028), mental component summary (MCS) score of SF-36 (OR=0.88, p=0.024), and TUG (OR=3.4, p=0.013). The strongest predictors for FOF one year postoperatively were fallers (OR=16.51, p=0.041), patients with ≥2 chronic diseases (OR=17.33, p=0.011), physical function score of WOMAC (OR=1.015, p=0.005), and MCS score of SF-36 (OR=0.86, p=0.015). Conclusion TKA positively affected FOF and gradually reduced the FOF rate over a year period after TKA in an elderly population.

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