title: Predictors of Patient-Reported Outcomes of Total Joint Arthroplasty in a Developing Country.
abstract: In response to the growing burden of joint disease, developing countries are starting to create their own total joint arthroplasty (TJA) programs. To date, there has been limited research on predictors of TJA outcomes in a developing country. This investigation uses patient-reported outcome measures collected by a medical mission to assess predictors of TJA outcomes in the Dominican Republic.
  
  
  
  Baseline and postoperative information from 156 of the mission's recipients of hip and knee TJA was used. Demographics were abstracted from clinical notes, and self-reported pain and functional status were assessed using Western Ontario and McMaster University Osteoarthritis Index and Short-Form 36 measures. Bivariate analysis identified variables to include in multivariable regression models of factors associated with function and pain outcomes and improvement in these domains 1 or 2 years postoperatively.
  
  
  
  The cohort had a mean age of 61.3 years, 82% were female, 79% had total knee arthroplasty, and 42% of the procedures were bilateral. In multivariate analyses, at P < .05, male sex, better preoperative function, and use of bilateral procedure were associated with better functional outcome. Male sex and worse preoperative pain were associated with better pain outcome. Worse preoperative pain and function, as well as bilateral surgery were associated with greater improvement in function. Additionally, a greater number of bothersome joints was associated with greater pain reduction.
  
  
  
  Our findings of better follow-up pain scores among patients with worse pain preoperatively and better functional improvement among those undergoing bilateral replacements contrast with study results from developed countries. The explanations for these observations merit further study.
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bido
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ying H
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Collins
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Yan
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Driscoll
authors.affiliation: Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Alcantara
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Thornhill
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008493:Medical Missions; D008875:Middle Aged; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000601:surgery; D010146:Pain / Q000601:surgery; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D020127:Recovery of Function; D057566:Self Report; D016896:Treatment Outcome; D055815:Young Adult
keywords: hip arthroplasty; international; knee arthroplasty; patient-reported outcomes; predictors of outcome