title: Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients' perspective.
abstract: OBJECTIVE
  To determine short-term improvements, satisfaction rates and the patient acceptable symptom state (PASS) after total joint replacement (TJR) for different patient-reported outcome measures (PROMs).
  
  
  METHODS
  This prospective cohort study included 426 consecutive patients undergoing total hip (n = 193) or knee arthroplasty (n = 233). The following PROMs were completed before TJR, and at 3, 6 and 12 months after surgery, respectively: WOMAC, Oxford Hip or Knee Score, Lower Extremity Functional Scale, University of California at Los Angeles (UCLA) activity scale and EuroQol-5 dimension (EQ-5D). Satisfaction rates and the PASS thresholds were also assessed.
  
  
  RESULTS
  THA patients improved quicker and achieved higher outcome scores than TKA patients. Comorbidities according to the Sangha score were moderately correlated with all PROM values in an inverse direction at all time points (r = -0.27 to -0.47, p < 0.01) in both groups. Satisfaction with the result of surgery improved over time. At 12 months, more than 90 % of the patients were satisfied or very satisfied with the achieved result. The THA group showed a higher proportion of very satisfied patients than the TKA group at all time points. PASS thresholds increased over time for all PROMs except for the UCLA and the EQ-5D in TKA patients.
  
  
  CONCLUSIONS
  More than 90 % of the patients will be satisfied 1 year after TJR. THA patients recover faster than TKA patients, i.e., they achieve higher PROM values at earlier follow-up time points. Cutoff values defining a successful result in terms of the PASS could be defined for all PROMs at different time points and can serve as reference for future studies and patient-oriented follow-ups.
authors.affiliation: Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. florian.naal@gmail.com.|Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, Zurich, Switzerland. florian.naal@gmail.com.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Naal
authors.affiliation: Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Franco M
authors.initials: FM
authors.lastname: Impellizzeri
authors.affiliation: Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lenze
authors.affiliation: Department of Research and Development, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wellauer
authors.affiliation: Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Eisenhart-Rothe
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Leunig
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life
keywords: Hip and knee arthroplasty; PASS; Patient-reported outcome; Satisfaction; Total joint replacement