Total knee replacement and health-related quality of life: factors influencing long-term outcomes.
OBJECTIVE
To evaluate health-related quality of life (HRQOL) in patients with osteoarthritis undergoing total knee replacement (TKR); identify the influence of sociodemographic, clinical, intraoperative, and postoperative variables on HRQOL; and determine patient perceptions at 7 years.


METHODS
We conducted a prospective study with 7 years of followup. HRQOL measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and Short Form 36 [SF-36]); sociodemographic, clinical, intraoperative, inpatient, and postoperative data; patient perceptions of TKR outcomes; and physical activity at 7 years were determined. Associations were analyzed using linear regression models.


RESULTS
Of 146 eligible patients, 112 (86 women, mean age 67.3 years) completed followup data. There were significant differences between pre- and postoperative WOMAC pain, stiffness, and function scores (P < 0.001). Variables retained in each of the models explained 14-32% (adjusted R(2)) of variability of the WOMAC dimensions. Obesity and postdischarge complications were associated with worse scores in all WOMAC dimensions (P < 0.05). Eighty-six percent of patients were satisfied with TKR, 80% would undergo the operation again, and 56% did regular physical activity and had better WOMAC scores (P < 0.05, except for stiffness [not significant]). Mean +/- SD SF-36 scores for men and women at 7 years were 55.1 +/- 27.1 and 39.5 +/- 22.9 for physical function, 71.2 +/- 36.5 and 51.5 +/- 42.7 for physical role, 66.2 +/- 26 and 55.6 +/- 28.9 for bodily pain, and 60.7 +/- 17.1 and 50.7 +/- 21.2 for general health, respectively.


CONCLUSIONS
WOMAC dimension scores, especially pain, significantly improved at 7 years and were negatively influenced by obesity and postdischarge complications. HRQOL measures may help identify an increased risk of negative outcomes after TKR.
Núñez
Montserrat
M
Biomedical Research Institute August Pi i Sunyer, Department of Rheumatology, Hospital Clínic, Barcelona, Spain. mnunez@clinic.ub.es
Lozano
Luis
L
Núñez
Esther
E
Segur
Josep M
JM
Sastre
Sergi
S
Maculé
Francisco
F
Ortega
Raquel
R
Suso
Santiago
S
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000601:surgery; D010146:Pain; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome