University of Technology Sydney. Graduate School of Health.Evidence-based management of osteoarthritis (OA) has progressed over the past decades. However, there are still evidence gaps related to the management of osteoarthritis, particularly for surgical options for total knee replacement (TKR) and total hip replacement (THR) and the factors affecting the outcomes of these procedures. This thesis investigates the relationship of potential contributors affecting outcomes of surgical management in osteoarthritis patients.
A prospective cohort study of 100 participants who underwent TKR and THR surgery was undertaken. Chapter 2 reports on the role of previous falls, falls risk, and psychological (pain catastrophizing, anxiety, depression) and functional factors such as Timed up and Go Test (TUG) and Choice Stepping Reaction Test (CSRT) associated with post-operative outcomes of length of hospital stay (LOS), need for inpatient rehabilitation, and need for community support services at discharge. We found that the presence of high level pre-operative pain catastrophizing and depression, and pre operative poorer function measured with TUG and CSRT, had positive associations with LOS. Pain catastrophizing and pre-operative falls were associated with an increased need for rehabilitation, and the CSRT with the need for community support services upon discharge.
Chapter 3 reports the change in falls, falls risk, and psychological factors prior to surgery to 6-weeks post-surgery. Of 100 participants described in Chapter 2, 68 participants completed the 6-week follow-up for this study. This study found that WOMAC, PCS, HADS scores improved from pre-and post- surgery of a total joint replacement. We found no differences on fall risk.
In summary, these studies showed that psychological factors, falls, and function are associated with post-operative outcomes of LOS, need for inpatient rehabilitation and services. The findings suggest the need for careful assessment and management of psychological factors, function, and falls in patients awaiting joint replacement surgery to improve pre- and post-operative outcomes. These findings empower clinicians and health managers to target relevant pre-operative factors and allocate resources appropriately leading to patient-centred care approach in patients undergoing TKR and THR procedures
