期刊论文详细信息
BMC Musculoskeletal Disorders
Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes
David G Lewallen1  Jasvinder A Singh1 
[1] Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
关键词: Function;    Pain;    Joint replacement;    Arthroplasty;    Time trends;    Total knee replacement;   
Others  :  1090366
DOI  :  10.1186/1471-2474-15-440
 received in 2014-06-16, accepted in 2014-12-10,  发布年份 2014
PDF
【 摘 要 】

Background

To examine whether function and pain outcomes of patients undergoing primary total knee arthroplasty (TKA) are changing over time.

Methods

The Mayo Clinic Total Joint Registry provided data for time-trends in preoperative and 2-year post-operative activity limitation and pain in primary TKA patients from 1993-2005. We used chi-square test and analysis for variance, as appropriate. Multivariable-adjusted analyses were done using logistic regression.

Results

In a cohort of 7,229 patients who underwent primary TKA during 1993-2005, mean age was 68.4 years (standard deviation (SD), 9.8), mean BMI was 31.1 (SD, 6.0) and 55% were women. Crude estimates showed that preoperative moderate-severe overall limitation were seen in 7.3% fewer patients and preoperative moderate-severe pain in 2.7% more patients in 2002-05, compared to 1992-95 (p < 0.001 for both). At 2-years, crude estimates indicated that compared to 1992-95, moderate-severe post-TKA overall limitation was seen in 4.7% more patients and moderate-severe post-TKA pain in 3.6% more patients in 2002-05, both statistically significant (p ≤ 0.018) and clinically meaningful. In multivariable-adjusted analyses that adjusted for age, sex, anxiety, depression, Deyo-Charlson index, body mass index and preoperative pain/limitation, patients had worse outcomes 2-year post-TKA in 2002-2005 compared to 1993-95 with an odds ratio (95% confidence interval (CI); p-value) of 1.34 (95% CI: 1.02, 1.76, p = 0.037) for moderate-severe activity limitation and 1.79 (95% CI: 1.17, 2.75, p = 0.007) for moderate-severe pain.

Conclusion

Patient-reported function and pain outcomes after primary TKA have worsened over the study period 1993-95 to 2002-05. This time-trend is independent of changes in preoperative pain/limitation and certain patient characteristics.

【 授权许可】

   
2014 Singh and Lewallen; licensee BioMed Central.

【 预 览 】
附件列表
Files Size Format View
20150128160431644.pdf 224KB PDF download
【 参考文献 】
  • [1]Healthcare Cost and Utilization Project. Most Frequent Procedures Performed in U.S. Hospitals. 2010. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb149.pdf webcite
  • [2]Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ 3rd, Kurland RL, Berry DJ: A population-based study of trends in the use of total hip and total knee arthroplasty, 1969-2008. Mayo Clin Proc 2010, 85(10):898-904.
  • [3]Cropp I: Why it costs $24,200 for a knee replacement. In Washington Post. Washington, D.C; 2011. http://www.washingtonpost.com/wp-dyn/content/article/2011/02/26/AR2011022603474.html webcite
  • [4]Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M: Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005, 87(7):1487-1497.
  • [5]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.
  • [6]Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR: Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012, 308(12):1227-1236.
  • [7]Kirksey M, Chiu YL, Ma Y, Della Valle AG, Poultsides L, Gerner P, Memtsoudis SG: Trends in in-hospital major morbidity and mortality after total joint arthroplasty: United States 1998-2008. Anesth Analg 2012, 115(2):321-327.
  • [8]Seah VW, Singh G, Yang KY, Yeo SJ, Lo NN, Seow KH: Thirty-day mortality and morbidity after total knee arthroplasty. Ann Acad Med Singapore 2007, 36(12):1010-1012.
  • [9]Skramm I, Saltyte Benth J, Bukholm G: Decreasing time trend in SSI incidence for orthopaedic procedures: surveillance matters! J Hosp Infect 2012, 82(4):243-247.
  • [10]Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY: Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004, 86-A(5):963-974.
  • [11]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 Relat Res 2003, 416:27-36.
  • [12]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 Cartilage 2010, 18(4):515-521.
  • [13]Singh JA, Lewallen DG: Time trends in the Characteristics of Patients Undergoing Primary Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2014. In press
  • [14]STROBE Statement. Strengthening the reporting of observational studies in epidemiology. Link. http://www.strobe-statement.org/index.php?id=available-checklists webcite
  • [15]McGrory BJ, Morrey BF, Rand JA, Ilstrup DM: Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 1996, 11(1):47-57.
  • [16]Insall JN, Dorr LD, Scott RD, Scott WN: Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989, 248:13-14.
  • [17]Riddle DL, Stratford PW, Bowman DH: Findings of extensive variation in the types of outcome measures used in hip and knee replacement clinical trials: a systematic review. Arthritis Rheum 2008, 59(6):876-883.
  • [18]Singh JA, Gabriel SE, Lewallen DG: Higher body mass index is not associated with worse pain outcomes after primary or revision total knee arthroplasty. J Arthroplasty 2011, 26(3):366-374. e361
  • [19]Singh JA, O’Byrne MM, Harmsen WS, Lewallen DG: Predictors of moderate-severe functional limitation 2 and 5 years after revision total knee arthroplasty. J Arthroplasty 2010, 25(7):1091-1095. 1095 e1091-1094
  • [20]Singh JA, O’Byrne MM, Colligan RC, Lewallen DG: Pessimistic explanatory style: a psychological risk factor for poor pain and functional outcomes two years after knee replacement. J Bone Joint Surg Br 2010, 92(6):799-806.
  • [21]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.
  • [22]Singh JA, Lewallen DG: Predictors of use of pain medications for persistent knee pain after primary Total Knee Arthroplasty: a cohort study using an institutional joint registry. Arthritis Res Ther 2012, 14(6):R248. BioMed Central Full Text
  • [23]Fisher DA, Dierckman B, Watts MR, Davis K: Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 2007, 22(6 Suppl 2):39-42.
  • [24]Jones CA, Voaklander DC, Suarez-Alma ME: Determinants of function after total knee arthroplasty. Phys Ther 2003, 83(8):696-706.
  • [25]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.
  • [26]Rajgopal V, Bourne RB, Chesworth BM, MacDonald SJ, McCalden RW, Rorabeck CH: The impact of morbid obesity on patient outcomes after total knee arthroplasty. J Arthroplasty 2008, 23(6):795-800.
  • [27]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45(6):613-619.
  • [28]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.
  • [29]Wasielewski RC, Weed H, Prezioso C, Nicholson C, Puri RD: Patient comorbidity: relationship to outcomes of total knee arthroplasty. Clin Orthop Relat Res 1998, 356:85-92.
  • [30]Lopez-Olivo MA, Landon GC, Siff SJ, Edelstein D, Pak C, Kallen MA, Stanley M, Zhang H, Robinson KC, Suarez-Almazor ME: Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis 2011, 70(10):1775-1781.
  • [31]Brander V, Gondek S, Martin E, Stulberg SD: Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 2007, 464:21-26.
  • [32]Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra SM, Reijman M: Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 2012, 41(4):576-588.
  • [33]Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D: The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012, 94(20):1839-1844.
  • [34]Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, Snyder-Mackler L: Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 2009, 61(2):174-183.
  • [35]Haugen IK, Englund M, Aliabadi P, Niu J, Clancy M, Kvien TK, Felson DT: Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis 2011, 70(9):1581-1586.
  • [36]Kopec JA, Rahman MM, Sayre EC, Cibere J, Flanagan WM, Aghajanian J, Anis AH, Jordan JM, Badley EM: Trends in physician-diagnosed osteoarthritis incidence in an administrative database in British Columbia, Canada, 1996-1997 through 2003-2004. Arthritis Rheum 2008, 59(7):929-934.
  • [37]Maxwell J, Niu J, Singh JA, Nevitt MC, Law LF, Felson D: The influence of the contralateral knee prior to knee arthroplasty on post-arthroplasty function: the multicenter osteoarthritis study. J Bone Joint Surg Am 2013, 95(11):989-993.
  • [38]Singh JA, Lewallen DG: Ipsilateral lower extremity joint involvement increases the risk of poor pain and function outcomes after hip or knee arthroplasty. BMC Med 2013, 11:144. BioMed Central Full Text
  • [39]Kamath AF, Horneff JG, Gaffney V, Israelite CL, Nelson CL: Ethnic and gender differences in the functional disparities after primary total knee arthroplasty. Clin Orthop Relat Res 2010, 468(12):3355-3361.
  • [40]Zeni JA Jr, Snyder-Mackler L: Most patients gain weight in the 2 years after total knee arthroplasty: comparison to a healthy control group. Osteoarthritis Cartilage 2010, 18(4):510-514.
  • [41]Wright RJ, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA: Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. J Bone Joint Surg Am 2004, 86-A(11):2464-2470.
  • [42]Ma Y, Balasubramanian R, Pagoto SL, Schneider KL, Hebert JR, Phillips LS, Goveas JS, Culver AL, Olendzki BC, Beck J, Olendzki BC, Beck J, Smoller JW, Sepavich DM, Ockene JK, Uebelacker L, Zorn M, Liu S: Relations of Depressive Symptoms and Antidepressant Use to Body Mass Index and Selected Biomarkers for Diabetes and Cardiovascular Disease. Am J Public Health 2013, 103(8):e34-e43.
  • [43]Zhang X, Bullard KM, Cotch MF, Wilson MR, Rovner BW, McGwin G Jr, Owsley C, Barker L, Crews JE, Saaddine JB: Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005-2008. JAMA Ophthalmol 2013, 131(5):573-581.
  • [44]Li C, Ford ES, Zhao G, Tsai J, Balluz LS: A comparison of depression prevalence estimates measured by the Patient Health Questionnaire with two administration modes: computer-assisted telephone interviewing versus computer-assisted personal interviewing. Int J Public Health 2012, 57(1):225-233.
  文献评价指标  
  下载次数:5次 浏览次数:9次