Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Understanding Early Recovery Following Primary Total Hip and Knee Replacement
Davis1, Aileen, Badley2, Elizabeth M., Hogg-Johnson3, Sheilah, Ibrahim3, Selahadin, Perruccio4, Anthony V., Wong1, Rosalind, Beaton5, Dorcas E.
Toronto Western Research Institute, Toronto, ON,
University of Toronto, Toronto, ON,
Institute for Work and Health. Toronto, ON,
Brigham & Women's Hospital and Harvard Medical School. Boston, MA,
St Michael's Hospital, Toronto, ON,
Baycrest Centre for Geriatric Care, Toronto, ON,
Toronto Rehabilitation Institute - Hillcrest Centre, Toronto, ON,
University Health Network, Toronto, ON
While baseline pain and functional status are known to predict these outcomes post total hip (THR) or knee (TKR) replacement in pre-post study designs, the trajectory of recovery has not been evaluated. This research evaluates the trajectory of recovery of symptoms, mood, physical function, and social and community participation for THR and TKR through six months post surgery.
Participants completed the HOOS or KOOS, measures of pain, physical function, and sports/leisure activities; the Jette Late Life Disability (LLD) and the Calderdale community mobility questions as measures of participation; the POMS (fatigue); and, the HADS (anxiety and depression) pre surgery, 2 weeks and 1, 3 and 6 months post surgery. Outcomes were all scored such that higher scores represented more problems. Recovery was compared for THR and TKR evaluating the impact of age, sex, and body mass index (BMI).
THR (n=437) patients had a mean age of 63 years, 55% were female, 34% were overweight (BMI=2529.9) and 35% were obese (BMI>30). TKR patients (n=494) had a mean age of 65 years, 65% were female, 38% were overweight and 45% were obese. Although symptoms, mood, activity and participation levels were similar pre-surgery, THR patients improved more rapidly and had better outcomes across measures than TKR patients at all times (p 0.049 to <0.0001). Age, sex and obesity all affected outcome (p<0.05). Older individuals (>64 years) had better mood and less activity limitations at baseline and to 2 weeks post surgery for THR, and to 1 month post surgery for TKR patients. Females reported worse outcomes irrespective of joint replaced. The exception was mood and activity limitations where women with TKR had worse outcome only to 1 month post surgery. Obese THR and TKR patients had higher pre-surgery scores for all outcomes with the exception of THR patients' mood. Obese TKR patients had more activity limitations at all times.
People with THR and TKR have different trajectories of outcome with TKR patients recovering more slowly and having poorer outcome than THR. Age, sex and obesity differentially affect different outcomes. These data have implications for the optimal timing of TKR surgery and rehabilitation service planning for THR and TKR.
To cite this abstract, please use the following information:
Davis, Aileen, Badley, Elizabeth M., Hogg-Johnson, Sheilah, Ibrahim, Selahadin, Perruccio, Anthony V., Wong, Rosalind, et al; Understanding Early Recovery Following Primary Total Hip and Knee Replacement [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1938