title: Important patient characteristics differ prior to total knee arthroplasty and total hip arthroplasty between Switzerland and the United States.
abstract: Outcomes after total knee (TKA) and hip (THA) arthroplasty are often generalized internationally. Patient-dependent factors and preoperative symptom levels may differ across countries. We compared preoperative patient and clinical characteristics from two large cohorts, one in Switzerland, the other in the US.
  
  
  
  Patient characteristics were collected prospectively on all elective primary TKAs and THAs performed at a large Swiss hospital and in a US national sample. Data included age, sex, education level, BMI, diagnosis, medical co-morbidities, PROMs (WOMAC pain/function), global health (SF-12).
  
  
  
  Six thousand six hundred eighty primary TKAs (US) and 823 TKAs (Swiss) were evaluated. US vs. Switzerland TKA patients were younger (mean age 67 vs. 72 years.), more obese (BMI ≥30 55% vs. 43%), had higher levels of education, more cardiac disease. Swiss patients had lower preoperative WOMAC pain scores (41 vs. 52) but pre-operative physical disability were comparable. 4,647 primary THAs (US) and 1,023 THAs (Swiss) were evaluated. US vs. Switzerland patients were younger (65 vs. 68 years.), more obese (BMI ≥30: 38% vs. 24%), had higher levels of education, more diabetes. Swiss patients had lower preoperative WOMAC pain scores (40 vs. 48 points). Physical disability was reported comparable, but Swiss patients indicated lower mental health scores.
  
  
  
  We found substantial differences between US and Swiss cohorts in pre-operative patient characteristics and pain levels, which has potentially important implications for cross-cultural comparison of TKA/THA outcomes. Reports from national registries lack detailed patient information while these data suggest the need for adequate risk adjustment of patient factors.
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Patricia.franklin@umassmed.edu.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Franklin
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
authors.forename: Hermes
authors.initials: H
authors.lastname: Miozzari
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Christofilopoulos
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ayers
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015992:Body Mass Index; D003431:Cross-Cultural Comparison; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D013557:Switzerland; D016896:Treatment Outcome; D014481:United States