title: Change of impairment, disability and patient satisfaction after total knee arthroplasty in secondary care practice.
abstract: OBJECTIVE
  To assess the evolution of impairment and disability after total knee arthroplasty (TKA) for osteoarthritis and to seek an association with patient satisfaction with surgery.
  
  
  METHODS
  Consecutives patients (n=45, 18 women) with osteoarthritis undergoing primary TKA in two secondary care inpatient clinics were prospectively assessed before one month and six months after surgery. Disability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-900) and the Lequesne Index (range 1-24). Patients' perceived handicap was assessed on a visual analog scale (VAS, range 1-100). At one month and six months postoperatively, kinetic strength of quadriceps and hamstrings was obtained by isokinetics measures and patient satisfaction on a VAS (range 1-100).
  
  
  RESULTS
  Mean age was 71.7+/-7.0 years; mean duration of symptoms was 38.3+/-33.4 months. Patient satisfaction was 83.9+/-17.7 and 83.1+/-22.4 at one month and six months after TKA, respectively. At one month, significant improvements were observed over baseline for pain (-30.73+/-32.2; p<0.01), physical function (Lequesne Index -2.28+/-3.6, p<0.01; and WOMAC score, -82.60+/-148.5, p<0.01), and patient perceived handicap (-21.84+/-29.6, p<0.01). A significant decrease in global knee range of motion was also observed. At six months, significant improvement was observed for pain (-47.96+/-26.8; p<0.01), physical function (Lequesne Index, -5.08+/-3.66, p<0.01; and WOMAC score, -157.04+/-153.2, p<0.01) and patient perceived handicap (-39.60+/-24.1; p<0.01). All isokinetics measures for quadriceps and hamstring were significantly improved between one month and six months after surgery. At one month and six months, the correlation between patient satisfaction and change in impairment, disability and patient perceived handicap was weak.
  
  
  CONCLUSIONS
  Impairment, disability and patient perceived handicap improved significantly after TKA for osteoarthritis. However, these improvements were poorly correlated with patient overall satisfaction with surgery.
authors.affiliation: Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France. francois.genet@rpc.aphp.fr
authors.forename: F
authors.initials: F
authors.lastname: Genêt
authors.forename: A
authors.initials: A
authors.lastname: Schnitzler
authors.forename: E
authors.initials: E
authors.lastname: Lapeyre
authors.forename: N
authors.initials: N
authors.lastname: Roche
authors.forename: K
authors.initials: K
authors.lastname: Autret
authors.forename: C
authors.initials: C
authors.lastname: Fermanian
authors.forename: S
authors.initials: S
authors.lastname: Poiraudeau
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology / Q000534:rehabilitation / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009985:Orthopedics; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013503:Surgery Department, Hospital