title: Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study.
abstract: BACKGROUND
  Although Total Hip and Knee Replacements (THR/TKR) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations. We aimed to assess whether the pre-operative radiographic severity of osteoarthritis (OA) is related to the improvement in HRQoL after THR or TKR, both at the population and individual level.
  
  
  METHODS
  In this multi-center observational cohort study, HRQoL of OA patients requiring THR or TKR was measured 2 weeks before surgery and at 2-5 years follow-up, using the Short-Form 36 (SF36). Additionally, we measured patient satisfaction on a 11-point Numeric Rating Scale (NRSS). The radiographic severity of OA was classified according to Kellgren and Lawrence (KL) by an independent experienced musculoskeletal radiologist, blinded for the outcome. We compared the mean improvement and probability of a relevant improvement (defined as a patients change score ≥ Minimal Clinically Important Difference) between patients with mild OA (KL Grade 0-2) and severe OA (KL Grade 3+4), whilst adjusting for confounders.
  
  
  RESULTS
  Severe OA patients improved more and had a higher probability of a relevant improvement in physical functioning after both THR and TKR. For TKR patients with severe OA, larger improvements were found in General Health, Vitality and the Physical Component Summary Scale. The mean NRSS was also higher in severe OA TKR patients.
  
  
  CONCLUSIONS
  Patients with severe OA have a better prognosis after THR and TKR than patients with mild OA. These findings might help to prevent dissatisfaction after THR and TKR by means of patient selection or expectation management.
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J Christiaan
authors.initials: JC
authors.lastname: Keurentjes
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.forename: Cynthia
authors.initials: C
authors.lastname: So-Osman
authors.forename: Ron
authors.initials: R
authors.lastname: Onstenk
authors.forename: Ankie W M M
authors.initials: AW
authors.lastname: Koopman-Van Gemert
authors.forename: Ruud G
authors.initials: RG
authors.lastname: Pöll
authors.forename: Herman M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Rob G
authors.initials: RG
authors.lastname: Nelissen
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011379:Prognosis; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome