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Rheumatology (Oxford). 2012 Oct;51(10):1804-13. Epub 2012 Apr 24.

Predictors of outcomes of total knee replacement surgery.

Author information

1
Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Headington, Oxford, UK. andrew.judge@ndorms.ox.ac.uk

Abstract

OBJECTIVE:

To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery.

METHODS:

The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome.

RESULTS:

The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than those with OA; deprivation-those living in poorer areas had worse outcomes; and anxiety/depression-worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome.

CONCLUSION:

This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient's expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes.

PMID:
22532699
DOI:
10.1093/rheumatology/kes075
[Indexed for MEDLINE]

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