Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Sports Science, Medicine and Rehabilitation
Published in: BMC Sports Science, Medicine and Rehabilitation 1/2013

Open Access 01-12-2013 | Research

Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study

Authors: François Desmeules, Clermont E Dionne, Étienne L Belzile, Renée Bourbonnais, François Champagne, Pierre Frémont

Published in: BMC Sports Science, Medicine and Rehabilitation | Issue 1/2013

Login to get access

Abstract

Background

Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA.

Methods

138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects’ medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores.

Results

Higher preoperative pain, cruciate retaining implants and the number of complications were significantly associated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain score. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed or retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations 6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL, contralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with worse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score.

Conclusions

Several variables were found to be significantly associated with worse outcomes 6 months after TKA and may help identify patients at risk of poorer outcome. The identification of these determinants could help manage patients more efficiently and may help target patients who may benefit from extensive rehabilitation.
Appendix
Available only for authorised users
Literature
1.
Forrest G, Fuchs M, Gutierrez A, Girardy J: Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty. 1998, 13 (2): 186-190. 10.1016/S0883-5403(98)90097-3.CrossRefPubMed
2.
Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME: Total joint arthroplasties: current concepts of patient outcomes after surgery. Clin Geriatr Med. 2005, 21 (3): 527-541. 10.1016/j.cger.2005.02.005. viCrossRefPubMed
3.
Brady OH, Masri BA, Garbuz DS, Duncan CP: Rheumatology: 10. Joint replacement of the hip and knee--when to refer and what to expect. Cmaj. 2000, 163 (10): 1285-1291.PubMedPubMedCentral
4.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007, 89 (4): 780-785. 10.2106/JBJS.F.00222.CrossRefPubMed
5.
Liang MH, Cullen KE, Larson MG, Thompson MS, Schwartz JA, Fossel AH, Roberts WN, Sledge CB: Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986, 29 (8): 937-943. 10.1002/art.1780290801.CrossRefPubMed
6.
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME: Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol. 2000, 27 (7): 1745-1752.PubMed
7.
Singh JA, O'Byrne M, Harmsen S, Lewallen D: Predictors of moderate-severe functional limitation after primary Total Knee Arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2010, 18 (4): 515-521. 10.1016/j.joca.2009.12.001.CrossRefPubMed
8.
Wylde V, Hewlett S, Learmonth ID, Dieppe P: Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011, 152 (3): 566-572. 10.1016/j.pain.2010.11.023.CrossRefPubMed
9.
Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG: Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008, 51 (6): 428-436.PubMedPubMedCentral
10.
Jones CA, Voaklander DC, Suarez-Alma ME: Determinants of function after total knee arthroplasty. Phys Ther. 2003, 83 (8): 696-706.PubMed
11.
Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI, Arenaza JC, Gutierrez LF: Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology (Oxford). 2007, 46 (1): 112-119. 10.1093/rheumatology/kel184.CrossRef
12.
Nunez M, Lozano L, Nunez E, Segur JM, Sastre S: Factors influencing health-related quality of life after TKA in patients who are obese. Clin Orthop Relat Res. 2011, 469 (4): 1148-1153. 10.1007/s11999-010-1671-3.CrossRefPubMed
13.
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH: Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999, 42 (8): 1722-1728. 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>3.0.CO;2-R.CrossRefPubMed
14.
Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, Liang MH, Ferland D, Phillips CB, Mahomed N: Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002, 46 (12): 3327-3330. 10.1002/art.10631.CrossRefPubMed
15.
Singh JA, Gabriel S, Lewallen D: The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res. 2008, 466 (11): 2717-2723. 10.1007/s11999-008-0399-9.CrossRefPubMedPubMedCentral
16.
Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe FJ, Simmonds M, Dunbar M: Psychological determinants of problematic outcomes following Total Knee Arthroplasty. Pain. 2009, 143 (1–2): 123-129.CrossRefPubMed
17.
Benjamin J, Johnson R, Porter S: Knee scores change with length of follow-up after total knee arthroplasty. J Arthroplasty. 2003, 18 (7): 867-871. 10.1016/S0883-5403(03)00264-X.CrossRefPubMed
18.
Parent E, Moffet H: Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Rheum. 2003, 49 (1): 36-50. 10.1002/art.10906.CrossRefPubMed
19.
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME: The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med. 2001, 161 (3): 454-460. 10.1001/archinte.161.3.454.CrossRefPubMed
20.
Mainard D, Guillemin F, Cuny C, Mejat-Adler E, Galois L, Delagoutte J: [Quality of life assessment one year after total hip or knee arthroplasty]. Rev Chir Orthop Reparatrice Appar Mot. 2000, 86 (5): 464-473.PubMed
21.
Desmeules F, Dionne CE, Belzile E, Bourbonnais R, Fremont P: The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery. Rheumatology (Oxford). 2010, 49 (5): 945-954. 10.1093/rheumatology/kep469.CrossRef
22.
Desmeules F, Dionne CE, Belzile EL, Bourbonnais R, Fremont P: The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract. 2010
23.
Desmeules F, Dionne CE, Belzile E, Bourbonnais R, Fremont P: Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life. BMC Musculoskelet Disord. 2009, 10 (1): 52-10.1186/1471-2474-10-52.CrossRefPubMedPubMedCentral
24.
Bellamy N, Buchanan WW: A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol. 1986, 5 (2): 231-241. 10.1007/BF02032362.CrossRefPubMed
25.
Choquette D, Bellamy N, Raynauld J: A French-Canadian version of the WOMAC Osteoarthritis Index. Arthritis Rheum. 1994, 37 (Suppl 9): S226.
26.
Bellamy N, Campbell J, Hill J, Band P: A comparative study of telephone versus onsite completion of the WOMAC 3.0 osteoarthritis index. J Rheumatol. 2002, 29 (4): 783-786.PubMed
27.
McConnell S, Kolopack P, Davis AM: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001, 45 (5): 453-461. 10.1002/1529-0131(200110)45:5<453::AID-ART365>3.0.CO;2-W.CrossRefPubMed
28.
Faucher M, Poiraudeau S, Lefevre-Colau MM, Rannou F, Fermanian J, Revel M: Assessment of the test-retest reliability and construct validity of a modified WOMAC index in knee osteoarthritis. Joint Bone Spine. 2004, 71 (2): 121-127. 10.1016/S1297-319X(03)00112-X.CrossRefPubMed
29.
Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992, 30 (6): 473-483. 10.1097/00005650-199206000-00002.CrossRefPubMed
30.
Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J, Coyte P: Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care. 1995, 33 (4 Suppl): AS131-144.PubMed
31.
Williams JI, Llewellyn Thomas H, Arshinoff R, Young N, Naylor CD: The burden of waiting for hip and knee replacements in Ontario. Ontario Hip and Knee Replacement Project Team. J Eval Clin Pract. 1997, 3 (1): 59-68. 10.1111/j.1365-2753.1997.tb00068.x.CrossRefPubMed
32.
Keller SD, Majkut TC, Kosinski M, Ware JE: Monitoring health outcomes among patients with arthritis using the SF-36 Health Survey: overview. Med Care. 1999, 37 (5 Suppl): MS1-9.PubMed
33.
Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML: Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 1999, 38 (9): 870-877. 10.1093/rheumatology/38.9.870.CrossRef
34.
Lingard EA, Katz JN, Wright EA, Sledge CB: Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004, 86-A (10): 2179-2186.PubMed
35.
Leplege A, Mesbah M, Marquis P: Preliminary analysis of the psychometric properties of the French version of an international questionnaire measuring the quality of life: the MOS SF-36 (version 1.1). Rev Epidemiol Sante Publique. 1995, 43 (4): 371-379.PubMed
36.
Ware JE, Jr , Kosinski M, Gandek B: SF-36 Health Survey: Manual & Interpretation Guide. 1993, Lincoln, RI: QualityMetric Incorporated, 2000.
37.
Xie F, Lo NN, Pullenayegum EM, Tarride JE, O'Reilly DJ, Goeree R, Lee HP: Evaluation of health outcomes in osteoarthritis patients after total knee replacement: a two-year follow-up. Health Qual Life Outcomes. 2010, 8: 87-10.1186/1477-7525-8-87.CrossRefPubMedPubMedCentral
38.
Hudon C, Fortin M, Vanasse A: Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol. 2005, 58 (6): 603-608. 10.1016/j.jclinepi.2004.10.017.CrossRefPubMed
39.
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity. a critical review of available methods. J Clin Epidemiol. 2003, 56 (3): 221-229. 10.1016/S0895-4356(02)00585-1.CrossRefPubMed
40.
Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V, Spazzafumo L, Mancinelli L, Espinosa E, Rappelli A: A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc. 2008, 56 (10): 1926-1931. 10.1111/j.1532-5415.2008.01935.x.CrossRefPubMed
41.
Daveluy C, Pica L, Audet N, Courtemanche R, Lapointe F: Enquête sociale et de santé 1998, 2e édition. 2000, Québec: Institut de la statistique du Québec, 2
42.
Julien M, Julien D, Lafontaine P: Environnement de Soutien Chapitre 25. In: Enquête sociale et de santé 1998. 1998, Québec: Institut de la statistique du Québec, 2
43.
Ilfeld FW: Further validation of a psychiatric symptom index in a normal population. Psychol Rep. 1976, 39: 1215-1228. 10.2466/pr0.1976.39.3f.1215.CrossRef
44.
Légaré G, Préville M, Massé R, Poulin C, St-Laurent D, Boyer R: Santé Mentale Chapitre 16. In: Enquête sociale et de santé 1998. 1998, Québec: Institut de la statistique du Québec, 2
45.
Préville M, Boyer R, Potvin L, Perrault C, G. L : La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’Enquête Santé Québec. Les cahiers de la recherche, 7, Enquête Santé Québec 87,Gouvernement du Québec, Ministère de la Santé et des Services Sociaux. 1992
46.
Rothman K, Greenland S: Modern Epidemiology. 1998, Philadelphia: Lippincott Williams & Wilkins, 2
47.
Conover W, Iman R: Rank transformations as a bridge between parametric and nonparametric statistics. Am Stat. 1981, 35 (3): 124-130.
48.
Kelly KD, Voaklander DC, Johnston DW, Newman SC, Suarez-Almazor ME: Change in pain and function while waiting for major joint arthroplasty. J Arthroplasty. 2001, 16 (3): 351-359. 10.1054/arth.2001.21455.CrossRefPubMed
49.
Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I: Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007, 15 (3): 273-280. 10.1016/j.joca.2006.09.001.CrossRefPubMed
50.
Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, Joseph L, Brown JP, Murray TM, Adachi JD: Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. Cmaj. 2000, 163 (3): 265-271.PubMedPubMedCentral
51.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T: Predicting total knee replacement pain: a prospective, observational study. Clin Orthop. 2003, 416: 27-36.CrossRefPubMed
52.
Nunez M, Lozano L, Nunez E, Segur JM, Sastre S, Macule F, Ortega R, Suso S: Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum. 2009, 61 (8): 1062-1069. 10.1002/art.24644.CrossRefPubMed
53.
Jacobs WC, Clement DJ, Wymenga AB: Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2005, 4: CD004803.PubMed
54.
Ackerman IN, Graves SE, Wicks IP, Bennell KL, Osborne RH: Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery. Arthritis Rheum. 2005, 53 (5): 653-658. 10.1002/art.21439.CrossRefPubMed
55.
Hirvonen J, Blom M, Tuominen U, Seitsalo S, Lehto M, Paavolainen P, Hietaniemi K, Rissanen P, Sintonen H: Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls. Health Qual Life Outcomes. 2006, 4: 3-10.1186/1477-7525-4-3.CrossRefPubMedPubMedCentral
56.
Keefe FJ, Blumenthal J, Baucom D, Affleck G, Waugh R, Caldwell DS, Beaupre P, Kashikar-Zuck S, Wright K, Egert J: Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain. 2004, 110 (3): 539-549. 10.1016/j.pain.2004.03.022.CrossRefPubMed
57.
Kennedy DM, Stratford PW, Hanna SE, Wessel J, Gollish JD: Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord. 2006, 7: 100-10.1186/1471-2474-7-100.CrossRefPubMedPubMedCentral
Metadata
Title
Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study
Authors
François Desmeules
Clermont E Dionne
Étienne L Belzile
Renée Bourbonnais
François Champagne
Pierre Frémont
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Sports Science, Medicine and Rehabilitation / Issue 1/2013
Electronic ISSN: 2052-1847
DOI
https://doi.org/10.1186/2052-1847-5-2

Other articles of this Issue 1/2013

BMC Sports Science, Medicine and Rehabilitation 1/2013 Go to the issue

Case report

Subacromial impingement syndrome in a patient with hereditary multiple exostosis: a case report

Review

Obesity, knee osteoarthritis and knee arthroplasty: a review

Research

Influence of navigation system updates on total knee arthroplasty

Research article

Effects of neck pain on reaching overhead and reading: a case–control study of long and short neck flexion

Editorial

An interview with Michael Carmont, section editor for the surgery, traumatology, and rehabilitation section on sports traumatology research: acute, overuse and chronic problems, early return to play and long-term outcomes

Research article

A comparison land-water environment of maximal voluntary isometric contraction during manual muscle testing through surface electromyography