Impact of Age on Patient-Reported Outcome Measures in Total Knee Arthroplasty

Abstract

Patient expectations and demographics are vital factors in determining patient satisfaction and outcomes from total knee arthroplasty (TKA). This study was a retrospective chart review that analyzed data from TKA patients to determine the impact of age on patient-reported outcomes measures following TKA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford knee scores were collected as primary outcome measures from 356 consecutive patients who underwent TKA. Oxford knee scores were further divided into pain and function subscores. Patients were age categorized as <50, 50 to 59, 60 to 69, 70 to 79, and >79. Preoperative scores were compared among age categories including age category, gender, body mass index (BMI), and length of stay (LOS) in the model as fixed effects. Scores collected postoperatively (∼10, 30, 90, and 180 days postoperation) were analyzed as repeated measures including age category, day and their interaction, gender, BMI, LOS, and preoperative score in the model. Preoperative OXFORD scores significantly differed among age categories (p < 0.05) and were numerically higher for the older (≥60 years old) compared with younger patients (<60 years old). After adjusting for preoperative scores, postoperative WOMAC and overall, pain, and function OXFORD scores significantly differed among the age groups (p < 0.05), with patients younger than 60 years reporting the worst scores in the postoperative time period. Older patients reported better preoperative overall, pain, and function scores and greater post-TKA outcomes than younger patients. A better understanding of factors that influence patient-reported outcomes can help providers to better manage patient expectations.

Keywords

total knee arthroplasty - outcomes - age - pain - function

• References

• 1 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 (04) 780-785
• 2 Keenan AC, Wood AM, Arthur CA, Jenkins PJ, Brenkel IJ, Walmsley PJ. Ten-year survival of cemented total knee replacement in patients aged less than 55 years. J Bone Joint Surg Br 2012; 94 (07) 928-931
• 3 Keeney JA, Eunice S, Pashos G, Wright RW, Clohisy JC. What is the evidence for total knee arthroplasty in young patients?: a systematic review of the literature. Clin Orthop Relat Res 2011; 469 (02) 574-583
• 4 Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016; 28 (01) 1-15
• 5 Judge A, Arden NK, Cooper C. , et al. Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford) 2012; 51 (10) 1804-1813
• 6 Lošťák J, Gallo J, Zapletalová J. Patient satisfaction after total knee arthroplasty. Analysis of pre-operative and peri-operative parameters influencing results in 826 patients [in Czech]. Acta Chir Orthop Traumatol Cech 2016; 83 (02) 94-101
• 7 Pivec R, Issa K, Given K. , et al. A prospective, longitudinal study of patient satisfaction following total knee arthroplasty using the Short-Form 36 (SF-36) survey stratified by various demographic and comorbid factors. J Arthroplasty 2015; 30 (03) 374-378
• 8 Singh JA, Lewallen DG. Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology (Oxford) 2013; 52 (05) 916-923
• 9 Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all?. Knee 2007; 14 (06) 417-423
• 10 Zhang W, Lyman S, Boutin-Foster C. , et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am 2016; 98 (15) 1243-1252
• 11 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 35-43
• 12 Williams DP, Price AJ, Beard DJ. , et al. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 2013; 95-B (01) 38-44
• 13 Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012; 94 (07) 974-981
• 14 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 (03) 454-460
• 15 Mannion AF, Kämpfen S, Munzinger U, Kramers-de Quervain I. The role of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 2009; 11 (05) R139
• 16 Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients' expectations and satisfaction with total hip arthroplasty. J Arthroplasty 1997; 12 (04) 387-396
• 17 Garratt AM, Brealey S, Gillespie WJ. ; DAMASK Trial Team. Patient-assessed health instruments for the knee: a structured review. Rheumatology (Oxford) 2004; 43 (11) 1414-1423
• 18 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
• 19 Elmallah RD, Jauregui JJ, Cherian JJ, Pierce TP, Harwin SF, Mont MA. Effect of age on postoperative outcomes following total knee arthroplasty. J Knee Surg 2016; 29 (08) 673-678
• 20 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. ; National Joint Registry for England and Wales; Data from the National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br 2007; 89 (07) 893-900
• 21 Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 2006; 443 (443) 266-272
• 22 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 (12) 1833-1840
• 23 Murray DW, Fitzpatrick R, Rogers K. , et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89 (08) 1010-1014
• 24 Katz BP, Freund DA, Heck DA. , et al. Demographic variation in the rate of knee replacement: a multi-year analysis. Health Serv Res 1996; 31 (02) 125-140
• 25 Parvizi J, Nunley RM, Berend KR. , et al. High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 2014; 472 (01) 133-137
• 26 Peck CN, Childs J, McLauchlan GJ. Inferior outcomes of total knee replacement in early radiological stages of osteoarthritis. Knee 2014; 21 (06) 1229-1232
• 27 Mancuso CA, Sculco TP, Wickiewicz TL. , et al. Patients' expectations of knee surgery. J Bone Joint Surg Am 2001; 83-A [phone]
• 28 Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ. Patient-reported activity level after total knee arthroplasty. J Arthroplasty 2008; 23 (03) 401-407
• 29 Roubion RC, Fox RS, Townsend LA, Pollock GR, Leonardi C, Dasa V. Does marital status impact outcomes after total knee arthroplasty?. J Arthroplasty 2016; 31 (11) 2504-2507