title: The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement.
abstract: OBJECTIVE
  Primary total hip (THR) and knee (TKR) replacement outcomes typically include pain and function with a single time of follow-up post-surgery. This research evaluated the trajectory of recovery and inter-relationships within and across time of physical impairments (PI) (e.g., symptoms), activity limitations (AL), and social participation restrictions (PR) in the year following THR and TKR for osteoarthritis.
  
  
  METHODS
  Participants (hip: n=437; knee: 494) completed measures pre-surgery and at 2 weeks, 1, 3, 6 and 12 months post-surgery. These included PI (Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and Chronic Pain Grade); AL (HOOS/KOOS activities of daily living and sports/leisure activities); and, PR (Late Life Disability and the Calderdale community mobility). Repeated measures analysis of variance (RANOVA) was used to evaluate the trajectory of recovery of outcomes and the inter-relationships of PI, AL and PR were evaluated using path analysis. All analyses were adjusted for age, sex, obesity, THR/TKR, low back pain and mood.
  
  
  RESULTS
  THR: age 31-86 years with 55% female; TKR: age 35-88 years with 65% female. Significant improvements in outcomes were observed over time. However, improvements were lagged over time with earlier improvements in PI and AL and later improvements in PR. Within and across time, PI was associated with AL and AL was associated with PR. The magnitude of these inter-relationships varied over time.
  
  
  CONCLUSIONS
  Given the lagged inter-relationship of PI, AL and PR, the provision and timing of interventions targeting all constructs are critical to maximizing outcome. Current care pathways focusing on short-term follow-up with limited attention to social and community participation should be re-evaluated.
authors: Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada. adavis@uhnresearch.ca
authors: A M
authors: AM
authors: Davis
authors: A V
authors: AV
authors: Perruccio
authors: S
authors: S
authors: Ibrahim
authors: S
authors: S
authors: Hogg-Johnson
authors: R
authors: R
authors: Wong
authors: D L
authors: DL
authors: Streiner
authors: D E
authors: DE
authors: Beaton
authors: P
authors: P
authors: Côté
authors: M A
authors: MA
authors: Gignac
authors: J
authors: J
authors: Flannery
authors: E
authors: E
authors: Schemitsch
authors: N N
authors: NN
authors: Mahomed
authors: E M
authors: EM
authors: Badley
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D019091:Critical Pathways; D004185:Disability Evaluation; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D015207:Osteoarthritis, Hip / Q000534:rehabilitation / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000534:rehabilitation / Q000601:surgery; D010147:Pain Measurement / Q000379:methods; D012959:Socioeconomic Factors; D016896:Treatment Outcome