Patients with lower preoperative physical function undergoing total hip or knee replacement did not improve postoperatively to the level achieved by those with higher preoperative function.
Observational (n=379)
Yes
Does worse preoperative physical function predict worse postoperative physical function and pain at 6 months after total hip or knee replacement in patients with osteoarthritis?
Surgery performed later in the natural history of functional decline due to OA results in worse postoperative functional status.
OBJECTIVE: To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function. METHODS: This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study. RESULTS: Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement. CONCLUSION: Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.
Fortin et al. (Sun,) conducted a observational in Knee or hip osteoarthritis (OA) (n=379). Total hip or knee replacement vs. Higher preoperative physical function was evaluated on Physical function and pain due to OA. Patients with lower preoperative physical function undergoing total hip or knee replacement did not improve postoperatively to the level achieved by those with higher preoperative function.