title: Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery.
abstract: OBJECTIVE
  To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.
  
  
  METHODS
  This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.
  
  
  RESULTS
  Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement.
  
  
  CONCLUSIONS
  Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.
authors.affiliation: The Montreal General Hospital Research Institute, and McGill University, Quebec, Canada.
authors.forename: P R
authors.initials: PR
authors.lastname: Fortin
authors.forename: A E
authors.initials: AE
authors.lastname: Clarke
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
authors.forename: M
authors.initials: M
authors.lastname: Tanzer
authors.forename: D
authors.initials: D
authors.lastname: Ferland
authors.forename: C
authors.initials: C
authors.lastname: Phillips
authors.forename: A J
authors.initials: AJ
authors.lastname: Partridge
authors.forename: P
authors.initials: P
authors.lastname: Bélisle
authors.forename: A H
authors.initials: AH
authors.lastname: Fossel
authors.forename: N
authors.initials: N
authors.lastname: Mahomed
authors.forename: C B
authors.initials: CB
authors.lastname: Sledge
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006304:Health Status; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010003:Osteoarthritis / Q000601:surgery* / Q000628:therapy*; D011184:Postoperative Period; D011300:Preoperative Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome