The effects of total knee arthroplasty on physical functioning in the older population

Abstract

Objective. Clinical research provides convincing evidence that total knee arthroplasty (TKA) is safe and improves joint-specific outcomes. However, higher-level functioning associated with self care and independent living has not been studied. Furthermore, most previous studies of the effects of TKA relied on relatively small clinical samples. We undertook this study to estimate the effects of TKA on 3 levels of physical functioning in a national sample of older adults.Methods. Data were obtained from the Medicare Current Beneficiary Survey from 1992 to 2003. Medicare claims data identified participants with osteoarthritis of the knee who received TKA (n ‫؍‬ 259) or no TKA (n ‫؍‬ 1,816). Propensity scores were used to match treatment and no-treatment groups according to demographic characteristics, comorbid conditions, and baseline functioning. Three levels of physical functioning were examined as outcomes of TKA. These levels were represented by items on the Nagi Disability Scale, the Instrumental Activities of Daily Living (IADL) Scale, and the Activities of Daily Living (ADL) Scale. These items were measured after TKA and at comparable intervals for the no-treatment group. Average treatment effects were calculated for relevant Nagi Disability Scale, IADL Scale, and ADL Scale tasks.Results. Between baseline and outcome assessments, TKA recipients improved on all 3 levels of physical functioning; the no-treatment group declined. Statistically significant average treatment effects for TKA were observed for one or more tasks for each measure of physical functioning.Conclusion. TKA is associated with sizeable im-

Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study

“…This prospective study confirms earlier observations showing that TKA leads to improved performance in activities of daily living [12,18,19] and demonstrates that patient characteristics have a rather limited impact on the success of TKA operation in this respect. Few preoperative characteristics showed statistically significant association with the outcomes, and even then, their actual effect on the ADL score is low.…”

“…The response rate was satisfying at 67%. Often there has been a comparison group of non-operated patients in studies concerning mobility [12,18,40], causing inevitable selection bias. In the present prospective setting such a bias could be avoided.…”

“…However, the role of comorbidities in explaining this difference is not known. Studies have often focused on the possible predicting power of obvious demographic factors [18,19]. The criteria for surgery vary notably between surgeons [20,21], and the most deciding factors seem to be not directly health-related [22].…”

Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception

“…In addition, the finding corresponds with Groen, Stevens, Kersten, Reininga, and Van den Akker-Scheek (2012) who measured adherence to an activity regimen recommended to maintain health in patients who underwent total knee replacement and found that about forty of patients were not active enough to maintain their health and fitness [51] . The results disagree with George, Ruiz, and Sloan (2008) who found that patients who underwent TKR surgery improved on activities of daily living and instrumental activities of daily living [52] . In addition, the result is inconsistent with LütznerJörg (2016) who revealed that Knee Society Knee and Function scores improved significantly after TKR [53] .…”

Studying Disability Trends in Aging Populations

“…Among these three measures, the tasks reported in the Nagi scale are the most difficult to perform and the tasks reported in the ADL scale require the least functional capacity to perform (George et al 2008a(George et al , 2008b. Unlike ADLs-which are almost universally applicable-a number of items included among the IADL and Nagi tasks may not be applicable in all societies or populations.…”