Key result
Higher preoperative health-related quality of life was associated with higher postoperative quality of life (0.51 points higher per preoperative point for TKA and 0.37 points for THA), though these patients experienced less total improvement.
Why the study?
Do preoperative determinants (age, gender, BMI, HRQoL, functioning, pain) influence postoperative HRQoL, functioning, and pain in patients undergoing TKA or THA?
Meta-Analysis (n=4,183)
Yes
Do preoperative determinants (age, gender, BMI, HRQoL, functioning, pain) influence postoperative HRQoL, functioning, and pain in patients undergoing TKA or THA?
Mean Difference: 0.51 (95% CI 0.32–0.71)
Patients with better preoperative health status achieve better absolute postoperative outcomes after TKA and THA, although their relative improvement is smaller.
Clinicians should set realistic expectations for smaller gains in high-baseline patients; leaves open causal effects of preoperative optimization.
BACKGROUND: Previous research has identified preoperative determinants that predict health related quality of life (HRQoL), functioning and pain after total knee or hip arthroplasty (TKA/THA), but these differed between studies and had opposite directions. This may be due to lack of power and not adjusting for confounders. The present study aims to identify the preoperative determinants that influence health related quality of life (HRQoL), functioning and pain after total knee or hip arthroplasty (TKA/THA). METHODS: We pooled individual patient from 20 cohorts with OA patients data (n = 1783 TKA and n = 2400 THA) in the Netherlands. We examined the influence of age, gender, BMI and preoperative values of HRQoL, functioning and pain on postoperative status and total improvement. Linear mixed models were used to estimate the effect of each preoperative variable on a particular outcome for each cohort separately. These effects were pooled across cohorts using a random effects model. RESULTS: For each increase in preoperative point in HRQoL, the postoperative HRQoL increased by 0.51 points in TKA and 0.37 points in THA (SF-36 scale). Similarly, each point increase in preoperative functioning, resulted in a higher postoperative functioning of 0.31 (TKA) and 0.21 (THA) points (KOOS/HOOS-ADL scale). For pain this was 0.18 (TKA) and 0.15 (THA) points higher (KOOS/HOOS-pain scale) (higher means less pain). Even though patients with better preoperative values achieved better postoperative outcomes, their improvement was smaller. Women and patients with a higher BMI had more pain after a TKA and THA. Higher age and higher BMI was associated with lower postoperative HRQoL and functioning and more pain after a THA. CONCLUSIONS: Patients with a better preoperative health status have better outcomes, but less improvement. Even though the independent effects may seem small, combined results of preoperative variables may result in larger effects on postoperative outcomes.
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Hofstede et al. (2018) conducted a meta-analysis in Osteoarthritis of the hip and knee (n=4,183). Higher preoperative health-related quality of life (HRQoL) vs. Lower preoperative HRQoL was evaluated on Postoperative HRQoL after Total Knee Arthroplasty (TKA) (MD 0.51, 95% CI 0.32 to 0.71). Higher preoperative health-related quality of life was associated with higher postoperative quality of life (0.51 points higher per preoperative point for TKA and 0.37 points for THA), though these patients experienced less total improvement.
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