Long-term health related quality of life in total knee arthroplasty

BackgroundTo analyze evolution and factors related with greater gains in Health Related Quality of Life (HRQOL) and with a greater probability of exceed their corresponding minimal clinically important differences (MCID) in patients with Osteoarthritis of the knee, undergoing total knee arthroplasty (TKA) at long-term.MethodsData were obtained from two previously recruited multicenter cohorts of patients who underwent TKA in the Basque Country. Patients were follow-up at 6 months and 10 years after surgery. Patients completed specific and generic HRQOL questionnaires plus sociodemographic, and clinical data at 10 years. Associations were analysed using linear and logistic regression models.ResultsA total of 471 patients responded at 10-year follow-up. The multivariable analysis showed that low preoperative HRQOL scores, higher age, higher BMI, some comorbidities and readmissions at 6 months were associated with less gains in HRQOL. Apart from aforementioned, to have a peripheral vascular disease (odd ratio 0.49 (95% CI, 0.24-0.99)), complications (odd ratio 0.31 (95% CI, 0.11-0.91)), and readmissions within 6 months of discharge (odd ratio 2.12 (95% CI, 1.18-3.80)) were associated with a lower probability of exceeding the MCID. The effect sizes (ESs) of changes from baseline to 6 months (range, 1.20-1.96) and to 10 years (range, 1.54-1.99) were large in all dimensions, nevertheless the ESs from 6 months to 10 years were not appreciable for pain (ES = 0.03) or stiffness (ES = 0.09), and small for function (ES = 0.30).ConclusionsLow preoperative HRQOL scores, to be elderly, severe obesity, the presence of some comorbidities -depression and rheumatology disease-, having readmissions or complications and not having rehabilitation of discharge, are good predictors of long-term lower gains in HRQOL. Some other non-registered parameters of the follow-up may also influence those outcomes.Key Indexing Terms (MeSH terms):Health-Related Quality of Life, Knee Arthroplasty, Total, Osteoarthritis

Automated summary

This study aimed to analyze the factors related to greater gains in Health Related Quality of Life (HRQOL) and a greater probability of exceeding their corresponding minimal clinically important differences (MCID) in patients with Osteoarthritis of the knee undergoing total knee arthroplasty (TKA) in the long term. The results showed that lower preoperative HRQOL scores, older age, higher BMI, certain comorbidities, and readmissions at 6 months were associated with lower gains in HRQOL. In addition, having peripheral vascular disease, complications, and readmissions within 6 months of discharge were associated with a lower probability of exceeding the MCID. The study also found that the changes in HRQOL from 6 months to 10 years were not significant for pain or stiffness, and only small for function.