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Arthritis Rheum. 2013 Dec;65(12):3304-13. doi: 10.1002/art.38139.

Progressing toward, and recovering from, knee replacement surgery: a five-year cohort study.

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1
Virginia Commonwealth University, Richmond.

Abstract

OBJECTIVE:

To determine the trajectories of preoperative worsening and postoperative recovery for both the index knee and the contralateral knee of patients undergoing knee replacement surgery.

METHODS:

Of the 4,796 subjects in the Osteoarthritis Initiative cohort study database, we examined 5-year data from 177 patients who underwent isolated unilateral knee replacement surgery and no other joint replacement surgery. Patient-reported outcomes captured domains defined by the International Classification of Functioning, Disability, and Health. Domains of knee structure and function, activity limitation, and participation restriction were examined using growth-curve modeling over 5-year periods prior to and following surgery.

RESULTS:

Preoperative worsening of the index knee was substantial in all domains of knee impairment, activity limitation, and societal participation. Pain intensity worsened only slightly from 5 years to 2.5 years prior to surgery, but worsened by ∼2 points (0-10-point scale) during the 2.5 years prior to surgery. Trajectories of improvement following surgery varied depending on the outcome measure. The contralateral knee also changed over time, such that by ∼2 years following surgery, pain was worse and by 3 years, activity limitation was worse in the contralateral knee as compared to the index knee.

CONCLUSION:

Patients who elect to undergo knee replacement surgery demonstrate perioperative trajectories of change that influence most health domains for both the index knee and the contralateral knee. After a period of no change, escalation of pain and worsening functioning in the index knee begins ∼2.5 years prior to surgery, which may be a key trigger for surgery.

PMID:
23983118
DOI:
10.1002/art.38139
[Indexed for MEDLINE]
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