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Differences in 1‑year outcome after primary total hip and knee arthroplasty

A cohort study in older patients with osteoarthritis

Unterschiede im 1‑Jahres-Ergebnis nach primärer Hüft- und Knieendoprothetik

Eine Kohortenstudie mit älteren Arthrosepatienten

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Abstract

Background

Patients who undergo primary total hip (THA) and knee (TKA) arthroplasty show better clinical outcomes, improved quality of life and increased participation in leisure activities; however, the differences between primary THA and TKA in older patients are unknown.

Objective

The aim of the study was to compare the Western Ontario and McMasters University osteoarthritis index (WOMAC) scores and changes in WOMAC scores, the Medical Outcomes study 12-item short-form version 2 (SF-12) mental and physical health scales, satisfaction and frequency of participation in leisure activities in older osteoarthritis patients with a mean age of 67.9 ± 10.6 years who underwent primary THA and TKA.

Material and methods

Data from 170 THA and 169 TKA patients were collected 1 week preoperatively through self-reporting of WOMAC scores and SF-12. These parameters, level of satisfaction and frequency of participation in leisure activities were collected 1 year postoperatively by self-reporting questionnaires.

Results

The THA group of patients showed better WOMAC scores (P < 0.05), changes in WOMAC scores (P < 0.05), physical component summary (PCS) of SF-12 (P < 0.01) and changes in PCS scores (P < 0.01) compared with the TKA group. In addition, the THA patients showed higher overall satisfaction (91.90% vs. 83.60%), pain relief satisfaction (87.20% vs. 77.40%) and functional improvement satisfaction (90.10% vs. 83.08%) in comparison with the TKA patients. Furthermore, a higher frequency of participation in leisure activities was achieved in THA patients, except for intellectual leisure activities.

Conclusion

These findings suggest that primary THA provides superior clinical outcomes, quality of life, satisfaction, and participation in leisure activities compared with primary TKA in older patients.

Zusammenfassung

Hintergrund

Bei Patienten, die sich einer primären THA- bzw. TKA („total hip arthroplasty“ bzw. „total knee arthroplasty“) unterziehen, zeigen sich bessere klinische Ergebnisse, eine verbesserte Lebensqualität und eine erhöhte Teilnahme an Freizeitaktivitäten; die Unterschiede zwischen primärer THA und TKA bei älteren Patienten sind jedoch unbekannt.

Zielsetzung

Ziel der Studie war es, die Therapieergebnisse nach primärer THA und TKA bei älteren Arthrosepatienten (Durchschnittsalter 67,9 ± 10,6 Jahre) vergleichend zu überprüfen anhand des WOMAC(Western Ontario und McMasters University Osteoarthritis)-Index, der Veränderungen in der WOMAC-Scores, des für die Medical Outcomes Study entwickelten SF-12 (12-Item Short Form Health Survey; Kurzform), Skalen für mentale und physische Gesundheit und Teilhabe an Freizeitaktivitäten.

Material und Methoden

Die Daten von 170 THA- und 169 TKA-Patienten wurden eine Woche präoperativ mittels WOMAC-Scores und SF-12 durch Selbstauskunft erhoben. Diese Parameter, der Grad der Zufriedenheit und die Häufigkeit der Teilnahme an Freizeitaktivitäten, wurden ein Jahr nach der Operation durch Selbstauskunft erneut erhoben.

Ergebnisse

Die THA-Patientengruppe zeigte im Vergleich zur TKA-Gruppe bessere Werte im WOMAC-Index (p < 0,05) und bei den WOMAC-Veränderungen (p < 0,05) sowie in der PCS(„physical component summary“)-Zusammenfassung des SF-12 (p < 0,01). Darüber hinaus stellten sich bei THA-Patienten im Vergleich zu TKA-Patienten eine höhere Gesamtzufriedenheit (91,9 vs. 83,60 %), Schmerzlinderung (87,20 vs. 77,40 %) und funktionelle Verbesserung (90,1 vs. 83,0 8%) dar. Ferner wurde (mit Ausnahme von intellektuellen Beschäftigungen) bei den Patienten der THA-Gruppe eine höhere Häufigkeit der Teilnahme an Freizeitaktivitäten erreicht.

Fazit

Diese Ergebnisse deuten darauf hin, dass die primäre THA im Vergleich mit einer primären TKA bei älteren Arthrosepatienten zu einem besseren klinischem Ergebnis führt und zu besseren Resultaten hinsichtlich Lebensqualität, Zufriedenheit und Teilnahme an Freizeitaktivitäten.

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Abbreviations

MCS:

Mental component summary score

OA:

Osteoarthritis

PCS:

Physical component summary score

SCQ:

Self-administered comorbidity questionnaire

SF-12:

Medical outcomes study 12-item short-form

THA:

Total hip arthroplasty

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario and McMasters University osteoarthritis index

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Funding

This study was funded by Shenzhen Second People’s Hospital in 2017 annual clinical research project (No. 20173357201804).

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Authors and Affiliations

  1. Rehabilitation Medicine, Shenzhen Second People’s Hospital, No. 3002 Sungang West Road, 518035, Shenzhen, People’s Republic of China

    Haohan Zhai, Hongni Geng & Yulong Wang

  2. Orthopedics, First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, People’s Republic of China

    Bo Bai

Authors
  1. Haohan Zhai
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  2. Hongni Geng
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  4. Yulong Wang
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Corresponding author

Correspondence to Yulong Wang.

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Conflict of interest

H. Zhai, H. Geng, B. Bai and Y. Wang declare that they have no competing interests.

The present investigation was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University.

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Zhai, H., Geng, H., Bai, B. et al. Differences in 1‑year outcome after primary total hip and knee arthroplasty. Orthopäde 48, 136–143 (2019). https://doi.org/10.1007/s00132-018-3636-2

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