High Pre-Operative Expectations Precede Both Unfulfilled Expectations and Clinical Improvement After Total Hip and Total Knee Replacement

Hafkamp, Frederique J.; Vries, Jolanda De; Gosens, Taco; Oudsten, Brenda L. Den

doi:10.1016/j.arth.2020.02.061

Cited by 12 publications

(18 citation statements)

References 65 publications

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“… 35 , 36 High preoperative expectations are associated with clinical improvement, including pain reduction. 37 Maintaining a stable emotional state and a positive attitude toward short-term discomfort are important for patients undergoing TKA. Additionally, patients should follow medical advice strictly and adhere to examinations, treatment, and rehabilitation exercises.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Quality of Life Before and After Total Knee Arthroplasty: A Multicenter Observational Study

Chang¹,

Fu²,

Cao³

et al. 2022

PPA

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Purpose To compare patients’ self-reported health-related quality of life (HRQoL) before and after total knee arthroplasty (TKA) and determine factors contributing to any heterogeneity in HRQoL. Patients and Methods This prospective multicenter observational study included 404 patients with knee osteoarthritis who underwent TKA between April 1, 2019 and December 30, 2019 and whose HRQoL was assessed preoperatively and 7 days and 1, 3, and 6 months postoperatively. Sociodemographic characteristics were assessed using a General Information Questionnaire, disability using the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS), resting pain using the visual analogue scale (Pain-VAS), and HRQoL using the European Quality of Life Five Dimension Five Level (EQ-5D-5L) scale. The growth mixture model was used to identify group heterogeneity in the developmental trajectories of KOOS-PS, Pain-VAS, and EQ5D5L. Logistic regression was used to explore the factors influencing the developmental trajectories of factors affecting the developmental trajectory of HRQoL. Results The mean EQ-5D-5L score improved from 0.69 preoperatively to 0.90 at 6 months postoperatively. Longitudinal heterogeneity in HRQoL was observed in patients during recovery: 1) patients with a small and slow improvement in HRQoL and 2) patients who showed marked and rapid improvement in HRQoL. The main characteristics of the latter group were decreasing VAS pain scores, a monthly family income >2000 CNY (100 CNY equals approximately 14.9 USD), exercising for <30 min daily, and better knee function at baseline. Baseline knee function and change in knee function were significantly associated with the percentage change in HRQoL. Conclusion HRQoL improved considerably after TKA. However, there was heterogeneity in the changes in HRQoL depending on patients’ socioeconomic status, exercise, and baseline knee function. Dynamic tracking of the HRQoL of TKA patients and timely provision of rehabilitation guidance will promote continuous improvement of the HRQoL of TKA patients.

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Quality of Life Before and After Total Knee Arthroplasty: A Multicenter Observational Study

Chang¹,

Fu²,

Cao³

et al. 2022

PPA

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“…Interestingly, preoperative expectations, as measured by MODEMS, did not show a significant correlation with 2-year PROMIS PF or improvement. Prior literature has shown that preoperative expectations are predictive of postoperative function in TKA and rotator cuff repair; however, [53][54][55] we are not aware of any studies that have investigated MODEMS and postoperative PROMIS PF specifically. MODEMS assesses expectations regarding multiple aspects of treatment in addition to return of function that may explain a lack of strong correlation with PROMIS PF.…”

Section: Discussionmentioning

confidence: 91%

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

et al. 2020

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The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

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“…For example, preoperative expectations contribute strongly to the final degree of satisfaction after primary THA (31). Additionally, preoperative expectations were positively related to improvement in pain and function after THA (32). Especially in younger patients, keen to return to work, sports, and physical social activities in their daily life, preoperative expec-tations might be high.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcome of 95% of young patients improves after primary total hip arthroplasty: identification of 3 recovery trajectories in 3,207 patients younger than 55 years from the Dutch Arthroplasty Register

Kuijpers

Steenbergen

Schreurs

et al. 2022

ActaO

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Background and purpose: Little is known about the outcome after receiving total hip arthroplasty (THA), specifically in young patients. We identified different recovery trajectories in young patients using data from the Dutch Arthroplasty Register (LROI). We also explored whether risk factors commonly associated with functional outcome were associated with recovery trajectory.Patients and methods: We used HOOS-PS score data up to 1 year postoperatively from the LROI from all patients younger than 55 years who received a primary THA between 2014 and 2019. To investigate whether different recovery trajectories could be distinguished, we performed latent class growth analysis (LCGA). Subsequently, we used multinomial logistic regression analyses to explore factors associated with class membership.Results: 3,207 patients were included. LCGA identified 3 groups of patients: optimal responders (75%), good responders (21%), and poor responders (4.7%). Female sex (RR 1.1; 95% CI 1.1–1.1), ASA II (RR 1.1; CI 1.0–1.1), ASA III–IV (RR 1.1; CI 1.0–1.2), smoking (RR 1.1; CI 1.0–1.1), cemented fixation (RR 1.2; CI 1.1–1.2), and a 22–28 mm head diameter (RR 1.1; CI 1.0–1.2) were associated with “good responder” class membership. ASA II (RR 1.1; 1.0–1.2), ASA III–IV (RR 1.2; 1.1–1.3), smoking (RR 1.2; CI 1.1–1.2), and hybrid fixation (RR 1.2; CI 1.0–1.2) were associated with “poor responder” class membership.Interpretation: 3 recovery trajectories could be identified. Female sex, higher ASA classifications, smoking, cemented or hybrid fixation, and small head diameter were associated with a suboptimal result after primary THA in young patients. These findings can aid in the process to determine which patients are at risk of a suboptimal outcome.

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High Pre-Operative Expectations Precede Both Unfulfilled Expectations and Clinical Improvement After Total Hip and Total Knee Replacement

Cited by 12 publications

References 65 publications

Patient-Reported Quality of Life Before and After Total Knee Arthroplasty: A Multicenter Observational Study

Patient-Reported Quality of Life Before and After Total Knee Arthroplasty: A Multicenter Observational Study

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

Patient-reported outcome of 95% of young patients improves after primary total hip arthroplasty: identification of 3 recovery trajectories in 3,207 patients younger than 55 years from the Dutch Arthroplasty Register

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