Determinants of Function After Total Knee Arthroplasty

Abstract

Background and Purpose. Decreasing hospital stays for patients with total knee arthroplasties (TKAs) have a direct effect on rehabilitation. The identification of modifiable determinants of postsurgical functional status would help physical therapists plan for discharge from hospitals. The purpose of this study was to identify preoperative determinants of functional status after a TKA. Participants. Using a community-based, prospective cohort study, data were collected from 276 patients who received a primary TKA in a Canadian health care region. Data were collected in the month before surgery and 6 months after surgery. Methods. Function was measured using the function subscale of a disease-specific measure—the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index—and a generic health status measure—the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Independent variables examined included demographic variables (eg, age, sex), medical variables (eg, diagnosis, number of comorbid conditions, ambulatory status), surgical variables (eg, type of implant, number of complications), and knee range of motion. Results. At 6 months after surgery, the average WOMAC physical function score was 70.5 (SD=18.2) and the average SF-36 physical function score was 44.8 (SD=25.3). Using multiple regression analyses, baseline function, walking device, walking distance, and comorbid conditions predicted 6-month function (WOMAC: R2=.20; SF-36 physical function: R2=.27). Discussion and Conclusion. Patients who have lower preoperative function may require more intensive physical therapy intervention because they are less likely to achieve functional outcomes similar to those of patients who have less preoperative dysfunction.

Follow‐up telephone calls to patients discharged after undergoing orthopaedic surgery: double‐blind, randomised controlled trial of efficacy

“…In contrast to other studies, the variables 'age' and 'sex' were not related to an increase in problems reported in the period after discharge (Meleis & Lindgren 2001, Jones et al 2003, Buurman et al 2010, Rytter et al 2010). This may be due to the fact that our study considered only medium-or low-intensity elective surgery, so old or fragile patients formed a small proportion of the study participants.…”

Preoperative psychological distress and functional outcome after knee replacement

“…15 Retrospective cohort study n = 8050 SF-12 SF-12 Higher odds of less functional gain were correlated to BMI over 40, lower preoperative MCS, each 5 year increase in age, poor or fair quadriceps strength and non-OA diagnosis Gandhi et al 16 Prospective cohort study n = 551 SF-36 SF-36, WOMAC Poorer mental health state were predictive of a less sustained functional outcome on both the WOMAC and SF-36 scale Heck et al 17 Prospective cohort study n = 291 SF-36 SF-36, WOMAC Better preoperative mental state and worse pre-operative knee function were the most important factors that were correlated to improvement in physical health. Jones et al 18 Prospective cohort study…”

“…Previous studies investigating the effect of preoperative psychological distress on post-operative function after different types of joint replacement show conflicting results. 4,[12][13][14][15][16][17][18][19][20][21][22] Furthermore, Howard et al 23 recently published a review investigating psychological factors possibly influencing outcomes after joint replacement pooling data for knee and hip joint replacements. However, since patients undergoing hip and knee joint replacement differ in age, gender and duration of disease, 24 comparison among these patients is not methodologically sound.…”

Preoperative Function and Gender Predict Pattern of Functional Recovery After Hip and Knee Arthroplasty

“…A growing number of studies suggest that poor preoperative functional status is associated with poorer outcome in terms of both function and pain after total joint arthroplasty [1][2][3][4][5]. This has important implications, particularly for women who, in a number of studies, have been shown to have more disability at the time of surgery and a willingness to accept greater decline in function before considering surgery [6][7][8][9][10].…”