Both primary total hip (THA) and knee (TKA) arthroplasty relieve pain, restore function, and increase mobility. Despite these successes, there is controversy as to whether THA or TKA provides greater or similar improvement. We therefore compared primary THA and TKA patient results in terms of (1) willingness to have surgery again; (2) WOMAC change score; (3) whether expectations were met; and (4) satisfaction. Patients undergoing primary THA were more willing to undergo their surgery again (THA 96%, TKA 89%), demonstrated greater WOMAC change scores, more frequently reported their expectations were met (THA 78%, TKA 70%), and expressed greater overall satisfaction (THA 89%, TKA 81%). In addition, patients undergoing THA expressed higher satisfaction with pain reduction while performing activities (ie, walking, stairs, and sitting/lying) and their ability to perform daily activities (ie, stairs, transportation, getting up, lying in bed, and light domestic duties) when compared with patients undergoing TKA. Our data suggest primary THA offers superior short-term outcomes when compared with primary TKA.
Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Sick Leave WOMAC Score Decision Date Maximize Response Rate High Functional Level
This is a preview of subscription content, log in to check access
We thank Mrs Susan Warner, Managing Director of the Ontario Joint Replacement Registry, and the Ontario orthopaedic surgeons who participated in the Ontario Joint Replacement Registry.
Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW. Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty. 1996;11:831–840.CrossRefPubMedGoogle Scholar
Bellamy N. WOMAC: a 20-year experiential review of a patient-centered self-reported health status questionnaire. J Rheumatol. 2002;29:2473–2476.PubMedGoogle Scholar
Bellamy N. WOMAC Osteoarthritis Index: A User’s Guide IX. London, Ontario, Canada: Professor Nicholas Bellamy; 2009.Google Scholar
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J. Influence of patient factors on TKA outcomes at 5 to 11 years follow-up. Clin Orthop Relat Res. 2007;464:27–31.PubMedGoogle Scholar
Bourne RB, Sibbald WJ, Doig G, Lee L, Adolph S, Robertson D, Provencher M. The Southwestern Ontario Joint Replacement Pilot Project: electronic point-of-care data collection. Southwestern Ontario Study Group. Can J Surg. 2001;44:199–202.PubMedGoogle Scholar
Chesworth BM, Mahomed NN, Bourne RB, Davis AM. Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery. J Clin Epidemiol. 2008;61:907–918.CrossRefPubMedGoogle Scholar
Dillman D. Mail and Electronic Surveys: The Tailored Design Method. New York, NY: John Wiley; 2000.Google Scholar
Escobar I, Quintana JM, Bilboa A, Arostegai I, Lafuente I, Vidarreta I. Responsiveness and clinically important differences for WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007;15:273–280.CrossRefPubMedGoogle Scholar
Ethgen O, Bruyere O, Richy R, Dardenne C, Reginster JV. Health-related quality of life in total hip and knee arthroplasty. A qualitative and systemic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.PubMedGoogle Scholar
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. Outcomes of total hip and knee replacement. Preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–1728.CrossRefPubMedGoogle Scholar
Guideline for Wait Time Thresholds for Total Hip and Knee Replacement Surgery Based on Severity. Detailed Report. London, Ontario: Ontario Joint Replacement Registry; 2006.Google Scholar
Janse AJ, Gemke RJ, Uiterwaal CS, van der Tweel I, Kimpen JL, Sinnema G. Quality of life: patients and doctors don’t always agree; a meta-analysis. J Clin Epidemiol. 2004;57:653–661.CrossRefPubMedGoogle Scholar
Jones CA, Voaklander DC, Suarez-Almazon ME. The effect of age on pain, function and quality of life after total hip and knee arthroplasty. Arch Intern Med. 2001;161:454–460.CrossRefPubMedGoogle Scholar
Laupacis A, Bourne RB, Rorabeck CH, Feeny D, Wong G, Tugwell P, Leslie K, Bullas R. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am. 1993;75:1619–1629.PubMedGoogle Scholar
Mahomed N, Sledge CB, Daltroy L, Fossel A, Katz J. Self-administered satisfaction scale for joint replacement arthroplasty. J Bone Joint Surg Br. 1998;80:63–69.CrossRefGoogle Scholar
Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29:1273–1279.PubMedGoogle Scholar
Quintana JM, Escobar A, Bilbao A, Arostegai I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. Osteoarthritis Cartilage. 2005;13:1076–1083.CrossRefPubMedGoogle Scholar
Rorabeck CH, Bourne RB, Laupacis A, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R. A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res. 1994;298:156–164.PubMedGoogle Scholar