Quality of life and patient satisfaction after total knee arthroplasty using contemporary designs

As medical and public health advances have led to enhanced treatments of existing diseases, and to delayed mortality, researchers have changed the way of examining health, looking beyond causes of mortality and morbidity and assessing the relationship of health to the quality of an individual life. The Constitution of the World Health Organization (WHO) defines health as "A state of complete physical, mental, and social well-being not merely the absence of disease" and thus the measurement of health and health care effects must include the changes in the frequency and severity of diseases as well as an estimation of well-being after appraising improvement in the quality of life (QoL) related to health care. Although there are generally satisfactory ways of measuring the frequency and severity of diseases this is not the case in the measurement of well-being and QoL [1]. QoL is a global concept that has different philosophical, political and health-related definitions. WHO defines QoL as individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. This broad concept is affected by a person's physical health, psychological state, level of independence, social relationships, personal beliefs, and relationship to salient features of his environment [2]. When QoL is considered in the context of health and disease, it is commonly referred to as health-related quality of life (HRQoL), to differentiate it from other aspects of quality of life. Since health is a multidimensional concept, HRQoL is also multidimensional and incorporates domains related to the physical, mental and emotional, and social functioning of an individual (Table 26.1) [3]. © Springer-Verlag London 2015

Surgical treatment of hip fractures: factors influencing mortality

Background: Data for osteoporotic hip fractures in Greece is limited and little is known upon the meaning of family support during the postoperative/rehabilitation period. Objective: To identify the factors influencing the mortality after hip fractures in the elderly, the effect of rehabilitation and family support in the post-fracture course, and the impact of these fractures on the family of the injured elderly. Methods: We conducted an observational study of 218 consecutive patients older than 60 years of age, who underwent surgical management of a unilateral hip fracture at a tertiary hospital of Central Greece, with follow-up contacts at 30 days, 3 months and one year. Demographic characteristics, pre- and post-fracture residential and functional status, assessment of basic activities of daily living (ADL), co-morbidities, type and mechanism of fracture and hospitalization data as well as the modification of activities of the patients' relatives were recorded. Results: Fifteen patients (6.9%) died during hospitalization; thirty-nine (17.9%) died within one year of fracture. The factors that were predictive of in-hospital, 30-days and one-year mortality, based on multivariate analysis, were male sex, advanced age >85 and Charson index >3. There was a significant association between delayed surgery (>48 hours) and increased in-hospital mortality. The percentage of patients assessed as ADL A or B at baseline, decreased form 84% preoperatively to 50.4% one year postoperatively. Only one-third of patients walking without aid before the fracture returned to the previous state. Family members modified their activities in 48% of cases to assist their relatives with a hip fracture. Conclusions: One-year mortality in patients with hip fractures was 17.9%. Surgical delay (>48 hours) increased inhospital mortality. Comorbidities >3, male sex, and advanced age increased the risk of in-hospital and post-discharge mortality during the 1st year. Twelve months postoperatively, half of patients walking without aid before the fracture returned to the previous state. Despite the beneficial effect of family support, the lack of organized rehabilitation programs and geriatric units are potential negative factors for patients' functional outcome. In addition, 48% of patients' relatives changed their daily activities to assist their relatives

Factors affecting the quality of life after total knee arthroplasties: A prospective study

Background: The purpose of the study is to evaluate the self-reported outcomes in the first year after primary total knee arthroplasty (TKA), and to determine factors influencing the quality of life (QoL) 6weeks, 3, 6, and 12months after TKA. Methods. A cohort of patients with knee osteoarthritis undergoing primary TKA at two hospitals (a regional university hospital and a capitals metropolitan hospital) was prospectively followed for 12months. Patients were assessed preoperatively and at 4 postoperative time-points, with the use of self-reported measurements for pain, physical function and depression with the following evaluation tools: Western Ontario and McMaster Osteoarthritis Index [WOMAC], Knee Society Scoring system [KSS], Centre for Epidemiological Studies Depression Scale, [CES-D10] and visual analog scale [VAS] for pain). General linear modelling for repeated measures was used to evaluate the effect of each independent variable including clinical and sociodemographic data. Differences between groups at different time points were tested by the independent samples t-test. Results: Of the 224 eligible patients, 204 (162 females, mean age 69.2) were included in the analysis. Response rate at one year was 90%. At 6weeks after surgery, despite improvement in pain and alleviation of the depressive mood, the physical function remained less satisfactory. Females presented lower scores in terms of quality of life, both preoperatively and 6weeks after TKA. Significant improvement was already experienced at 3months postoperatively. According to WOMAC, KSS, CES-D10 and pain VAS scores the Qol was significantly improved 12months after TKA (P<0.001). CES-D10 score was positively correlated with WOMAC and pain VAS scores at all the time points assessed (P<0.001). Age, body mass index (BMI), place of residence, level of education and social support were not significant predictors of QoL after TKA. Conclusions: Patients experienced great improvement in their QoL after TKA in spite of a less satisfactory physical function in the first 6weeks after surgery, with noticeable differences in the QoL among genders in the same time period. After that period all patients experienced significant improvement for all the measured parameters, until the third postoperative month with smaller changes thereafter. © 2012 Papakostidou et al.; licensee BioMed Central Ltd

Patient-reported quality of life after primary major joint arthroplasty: A prospective comparison of hip and knee arthroplasty

Background: To investigate and compare the impact of primary hip (THA) and knee (TKA) arthroplasty on quality of life in patients with osteoarthritis, to determine patients' satisfaction with total joint arthroplasty, and to detect the effect of patients' demographic and clinical characteristics on outcome. Methods: Three hundred seventy eight (378) patients with hip (174) and knee (204) osteoarthritis undergoing total joint arthroplasty (174 THA-204 TKA) were assessed pre- and post-operatively (6 weeks, 3, 6, and 12 months) using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and Centre for Epidemiological Studies Depression Scale (CES-D10). The patients' satisfaction with the results of total joint arthroplasty was also assessed. Differences were analyzed using general linear model for repeated measures. Results: The one-year response rate was 97 % for THA and 90 % for TKA. WOMAC and CES-D10 scores improved significantly after one year for both THA and TKA (P < 0.0001). The improvement in WOMAC total score was significantly greater for TKA patients (P < 0.0001 at 12 months). WOMAC pain and stiffness improved earlier for THA (6 weeks), while TKA had equivalent improvements at 3 and 6 months respectively. Both THA/TKA displayed significant improvement of WOMAC function at 3 months but TKA had greater improvement. Age, body mass index, residence, education and social support were not significant predictors of quality of life after total joint arthroplasty. One year postoperatively 88 % of patients were satisfied. Conclusions: WOMAC and CES-D10 improved significantly one year postoperatively. Although pain and stiffness improved earlier in THA, functional improvement was inferior in THA compared to TKA. © 2015 Dailiana et al

Patient-reported quality of life after primary major joint arthroplasty: A prospective comparison of hip and knee arthroplasty

Background: To investigate and compare the impact of primary hip (THA) and knee (TKA) arthroplasty on quality of life in patients with osteoarthritis, to determine patients' satisfaction with total joint arthroplasty, and to detect the effect of patients' demographic and clinical characteristics on outcome. Methods: Three hundred seventy eight (378) patients with hip (174) and knee (204) osteoarthritis undergoing total joint arthroplasty (174 THA-204 TKA) were assessed pre- and post-operatively (6 weeks, 3, 6, and 12 months) using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and Centre for Epidemiological Studies Depression Scale (CES-D10). The patients' satisfaction with the results of total joint arthroplasty was also assessed. Differences were analyzed using general linear model for repeated measures. Results: The one-year response rate was 97 % for THA and 90 % for TKA. WOMAC and CES-D10 scores improved significantly after one year for both THA and TKA (P < 0.0001). The improvement in WOMAC total score was significantly greater for TKA patients (P < 0.0001 at 12 months). WOMAC pain and stiffness improved earlier for THA (6 weeks), while TKA had equivalent improvements at 3 and 6 months respectively. Both THA/TKA displayed significant improvement of WOMAC function at 3 months but TKA had greater improvement. Age, body mass index, residence, education and social support were not significant predictors of quality of life after total joint arthroplasty. One year postoperatively 88 % of patients were satisfied. Conclusions: WOMAC and CES-D10 improved significantly one year postoperatively. Although pain and stiffness improved earlier in THA, functional improvement was inferior in THA compared to TKA. © 2015 Dailiana et al