Should we use conventional or functional performance measures for evaluation of immediate outcomes after TKA?

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Chavarin Amarase
Aree Tanavalee
Pathomporn Veerasethsiri
Srihatach Ngamukos

Abstract

Introduction: Recently, evaluation of outcomes following total knee arthroplasty (TKA) in the immediate postoperative period (≤ 12 weeks) has been frequently reported for efficiency of new surgical approaches or new pain management protocols. Several functional performance measures have been added to those of conventional tools. However, there has been no comparative evaluation of individual measures at a serial follow-up for immediate outcomes after TKA, in terms of time to significant improvement compared the preoperative period.


Methods: We prospectively evaluated 40 patients who had primary knee osteoarthritis and underwent uncomplicated TKA for immediate outcomes at postoperative 2nd week, 6th week, and 12th week, consecutively. All patients were evaluated for conventional outcome measures, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index and SF-36, as well as functional performance measures, including Time up and go test (TUGT) and 6-min walk distance (6MWD). The improvement of individual tests at each evaluation was compared to the preoperative period. 


Results: There were 37 females and 3 males. The patients’ mean age was 70.1 years, and mean body mass index (BMI) was 27.26 kg/m2. The majority of patients (97.5%) had ASA class I and II. At the 2nd week, several conventional measures, including WOMAC index and SF-36 provided significant improvement; however, all of the functional performance measures showed significantly worse parameters than those at the preoperative evaluation. Functional performance measures, including TUGT and 6MWD provided significant improved outcomes at the 12th week.


Conclusion: Conventional measures demonstrated faster outcome improvements after TKA than function performance.

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References

1. Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, et al. Knee replacement. Lancet. 2012;379(9823):1331-40.
2. Culliford DJ, Maskell J, Beard DJ, Murray DW, Price AJ, Arden NK. Temporal trends in hip and knee replacement in the United Kingdom: 1991 to 2006. J Bone Joint Surg Br. 2010;92(1):130-5.
3. Swedish Knee Arthroplasty Register. Annual report 2014, 2010, Swedish Knee Arthroplasty Register, Lund.
4. Inui H, Taketomi S, Nakamura K, Takei S, Takeda H, Tanaka S, et al. Influence of navigation system updates on total knee arthroplasty. BMC Sports Sci Med Rehabil. 2013;5:10.
5. Hofstede SN, Nouta KA, Jacobs W, van Hooff ML, Wymenga AB, Pijls BG, et al. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2015(2):CD003130.
6. Korean Knee S. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012;24(4):201-7.
7. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40.
8. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg (Br). 1998;80(1):63-9.
9. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.
10. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
11. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337-43.
12. Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66(2):228-41.
13. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989:13-4.
14. Dobson F, Hinman RS, Roos EM, Abbott JH, Stratford P, Davis AM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2013;21(8):1042-52.
15. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.
16. Jakobsen TL, Kehlet H, Bandholm T. Reliability of the 6-min walk test after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2625-8.
17. Garcia RM, Kraay MJ, Goldberg VM. Isolated resurfacing of the previously unresurfaced patella total knee arthroplasty. J Arthroplasty. 2010;25(5):754-8.
18. Wohlrab D, Hube R, Zeh A, Hein W. Clinical and radiological results of high flex total knee arthroplasty: a 5 year follow-up. Arch Orthop Trauma Surg 2009;129(1):21-4.
19. Tanavalee A, Rojpornpradit T, Khumrak S, Ngarmukos S. The early results of gender-specific total knee arthroplasty in Thai patients. Knee. 2011;18(6):483-7.
20. Kelly MA, Finley M, Lichtman SW, Hyland MR, Edeer AO. Comparative Analysis of High-Velocity Versus Low-Velocity Exercise on Outcomes After Total Knee Arthroplasty: A Randomized Clinical Trial. J Geriatr Phys Ther. 2015.
21. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty. 2014;29(11):2224-9.
22. Chan EY, Teo YH, Assam PN, Fransen M. Functional discharge readiness and mobility following total knee arthroplasty for osteoarthritis: a comparison of analgesic techniques. Arthritis Care Res (Hoboken). 2014;66(11):1688-94.
23. Gandek B. Measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index: a systematic review. Arthritis Care Res (Hoboken).2015;67:216-29.
24. Papathanasiou G, Stasi S, Oikonomou L, Roussou I, Papageorgiou E, Chronopoulos E, et al. Clinimetric properties of WOMAC Index in Greek knee osteoarthritis patients: comparisons with both self-reported and physical performance measures. Rheumatol Int. 2015;35(1):115-23.
25. Jacobs CA, Christensen CP. Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res. 2009;467(9):2414-9.
26. Giesinger JM, Kuster MS, Behrend H, Giesinger K. Association of psychological status and patient-reported physical outcome measures in joint arthroplasty: a lack of divergent validity. Health Qual Life Outcomes. 2013;11:64.
27. Mammoto T, Fujie K, Mamizuka N, Taguchi N, Hirano A, Yamazaki M, et al. Effects of postoperative administration of celecoxib on pain management in patients after total knee arthroplasty: study protocol for an open-label randomized controlled trial. Trials. 2016;17:45.
28. Harsten A, Hjartarson H, Werner MU, Toksvig-Larsen S. General anaesthesia with multimodal principles versus intrathecal analgesia with conventional principles in total knee arthroplasty: a consecutive, randomized study. J Clin Med Res. 2013;5(1):42-8.
29. Gandhi R, Tsvetkov D, Davey JR, Syed KA, Mahomed NN. Relationship between self-reported and performance-based tests in a hip and knee joint replacement population. Clin Rheumatol. 2009;28(3):253-7.
30. Stratford PW, Kennedy DM, Maly MR, Macintyre NJ. Quantifying self-report measures' overestimation of mobility scores postarthroplasty. Phys Ther. 2010;90(9):1288-96.
31. Mizner RL, Petterson SC, Clements KE, Zeni JA, Jr., Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011;26(5):728-37.