Health benefits of joint replacement surgery for patients with osteoarthritis: prospective evaluation using independent assessments in Scotland

Abstract

Study objectives-To determine extent of change in psychological, functional, and social health after knee and hip joint replacement surgery using independent assessments. Design-Patients were recruited before surgery and interviewed preoperatively, three months after surgery, and nine months after surgery. Interviews were conducted in the patients' own homes. Setting-Two orthopaedic surgery units in Scotland. Participants-A consecutive sample of 107 patients with osteoarthritis having primary replacement of the knee or hip. Main outcome measures-Assessments of depression, anxiety, pain, functional activity, informal care, and formal service utilisation were made at three time points. Main results-Anxiety and pain were significantly reduced and functional activity levels significantly increased after surgery. While gains in anxiety and pain reduction occurred between the preoperative and three month assessments, gains in activity were made between the three month and nine month assessments. Although pain was reduced and activity increased, levels of depression were unchanged after surgery. Patients reported need for assistance with fewer activities after surgery, but increases in the use of formal services and increases in the number of hours per week of informal support received were observed at both three month and nine month follow up. Conclusions-The main benefit of joint replacement surgery is pain relief. Gains in functional activity, particularly mobility and leisure activities are made by many patients. Paradoxically, surgery for osteoarthritis seems to act as a "gateway" to increases in formal and informal community support, which are maintained into the longer term.

The impact of pre-operative obesity on weight change and outcome in total knee replacement

“…5 However, loss of weight in obese patients awaiting surgery is difficult, partly because the symptoms limit their ability to exercise, and they often believe that joint replacement is crucial for weight loss. Improvements of function and quality of life (QoL) occur within three months of TKR, [6][7][8][9] and thus the perceived barrier to weight loss should be removed at this time. There is, however, little information on the impact of TKR on subsequent weight loss, although it has been suggested that this may not occur after TKR.…”

Nursing contributions to mobilizing older adults following total hip replacement in Ireland

“…The nurses' perception may have been influenced by the fact that the majority of patients commence full weight bearing on the operated leg by the second post-operative day (Lucas, 2004). Therefore, in the absence of collaborative problems improvement in the individual's ambulatory, recreational and occupational function can be anticipated from an early stage (Orbell et al, 1998). Young et al (1999) contended that the concept of rehabilitation must reflect not just the function of a body part alone but of the whole person, set in the context of their personal circumstances.…”

Obesity and symptomatic osteoarthritis of the knee

“…Improvements in function and quality of life occur within three months of TKR so the perceived obstacle to weight loss should be lifted by this time. [72][73][74][75] A prospective, continuous study of 529 patients who underwent primary TKR was recently reported by Dowsey et al 76 They aimed to investigate weight change and the functional and clinical outcome in non-obese and obese groups 12 months post-operatively. After 12 months, 40 (12.6%) of the obese patients had achieved a clinically significant weight loss of 5%, but 107 (21%) had actually gained weight.…”