Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty☆

Dash, Sunil K.; Palo, Nishit; Arora, Geetanjali; Chandel, Sidharth S.; Kumar, Mithilesh

doi:10.1016/j.rboe.2016.12.011

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ORIGINAL ARTICLE • Rev. bras. ortop. 52 (04) • Jul-Aug 2017 • https://doi.org/10.1016/j.rboe.2016.12.011 copy

Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty^☆ ☆ Work performed in the centers in Bhubaneswar, Odisha, India.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

Prospectively analyze the effect of preoperative walking status and the patient's surgical education on functional outcomes and the three dimensions of quality of life (QoL) (pain, physical function, and mental health) after elective total knee arthroplasty (TKA).

METHODS:

A comparative analysis on the QoL and functional outcomes in patients who underwent total knee arthroplasty between January 2014 and June 2015. To compare effects of the patient's walking status and knowledge of the surgical procedure on QoL and functional outcomes following TKA by means of SF-36 questionnaire, CES D10, VAS, KSS, KSFS, WOMAC, as well as Friedmann and Wyman scores, 10MWT, and 30-second timed chair test, assessed before the operation and one, three, and six months after the operation.

RESULTS:

There were 168 knees in 154 patients: 46.75% men and 53.24% women. 52.38% of knees had grade-III OA and 40.47% of knees had grade-IV OA. Preoperatively, SF-36 PCS was 33.2 and MCS was 35.4. Mean KSS and KSFS in females was 37.3 (16.2) and 31.5 (13.8); in males it was 49.2 (18.4) and 42.5 (15.7), respectively. Mean WOMAC scores were 64.2 in females and 56.5 in males. Mean VAS and CES D10 scores were 8.8 and 8.2 in females, and 6.9 and 6.4 in males, respectively. Post operatively at the first, third, and sixth month, significant improvements in QoL and mean SF-36, CES D10, VAS, KSS, KSFS, WOMAC, and Friedmann and Wyman scores were observed, as well as in the 10MWT and 30 s timed chair test scores. Patients with better preoperative functional activity and satisfactory understanding of TKA presented a better functional performance and achieved a good quality life (p< 0.01).

DISCUSSION:

Surgeons educate TKA candidates regarding the surgical procedure, the nature of implants, and how the procedure would affect their lifestyle and what their expectations from TKA should be. These crucial considerations should boost their confidence, enhancing their involvement and cooperation in post-surgical rehabilitation, thereby improving their QoL, functional results, and post TKA experience.

CONCLUSION:

TKA candidates with good preoperative walking ability and understanding of knee arthroplasty have better QoL in early and late post-surgery periods. Patient's lifestyle and understanding significantly enhances the postoperative functional ability.

Keywords:
Arthroplasty, replacement, knee; Biomechanical phenomena; Knee joint; Quality of life; Treatment outcome

Grade	Description
Knees
0	Normal
1	Doubtful narrowing of joint space and possible osteophytic lipping
2	Definite osteophytes and possible narrowing of joint space
3	Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis, and possible deformity of bone ends
4	Large osteophytes, marked narrowing of joint space, severe sclerosis, and definite deformity of bone ends. Subchondral cysts may be present.
Hips
0	Normal
1	Possible narrowing of joint space medially and possible osteophytes around the femoral head
2	Definite narrowing of joint space inferiorly, definite osteophytes, and slight sclerosis
3	Marked narrowing of joint space, slight osteophytes, some sclerosis and cyst formation, and deformity of femoral head and acetabulum
4	Gross loss of joint space with sclerosis and cysts, marked deformity of femoral head and acetabulum, and large osteophytes

Variables	Female (82)		Male (72)
	N	%	N	%
1. Knee (range of movements) (n = 168)
0–60° Flexion	42	51.2	28	38.8
61–80° Flexion	21	25.6	22	30.5
81–100° Flexion	12	14.6	13	18.0
100–120° Flexion	7	8.5	9	12.7
2. Educational status (n = 154)
Grade 8 or lower	17	20.7	10	13.8
Grade 9–12	33	40.3	18	25.0
Bachelor's degree	20	24.3	26	36.2
Post-graduate degree	12	14.7	18	25.0
3. Comorbities (n = 154)
Hypothyroidism	26	31.7	18	25
Diabetes mellitus	51	62.1	38	52.7
Hypertension	45	54.8	43	59.7
Parkinson disease	2	2.4	5	6.9
Alzheimer	3	3.6	8	11.1

Variables	Female knee (92)		Male knee (90)
	Mean	S.D.	Mean	S.D.
1. WOMAC scores
Pain	14.3	4.2	13.6	3.8
Function	44.7	14.6	38.5	10.5
Stiffness	5.2	1.6	4.4	1.8
2. KSS
Knee score	37.3	16.2	49.2	18.4
Function score	31.5	13.8	42.5	15.7
3. 30 second chair test	3	1.2	4	2
4. VAS	8.8	1.2	6.9	2.9
5. CES D10	8.2	1.4	6.4	2.4
	N	%	N	%
6. Friedmann–Wyman score
Good	17	20.7	10	13.8
Fair	33	40.3	18	25.0
Poor	20	24.3	26	36.2
7. Walking ability
Gr. IV	8	8.6	9	10
Gr. III	12	13.0	11	12.2
Gr. II	41	44.8	41	45.6
Gr. I	31	33.6	29	32.2

Variables	1st month		3rd month		6th month
	Mean	S.D.	Mean	S.D.	Mean	S.D.
1. WOMAC scores
Pain	6.3	1.2	3.2	1.1	2	0.8
Function	21	8.6	16.4	6.4	10.2	7.8
Stiffness	3.8	1.1	2.2	0.8	1.8	1
2. KSS
Knee score	64.2	12.4	72.8	16.8	78.2	17.2
Function score	55.8	10.6	64.2	12.4	68	12.8
3. 30 second chair test	4	1.8	4	2	5	2.4
4. VAS:	5.8	2.2	4.2	1.4	3	0.8
5. CES D10:	4.2	0.8	3.4	1	2.8	0.6
6. Friedmann–Wyman score	N	%	N	%	N	%
Good	48	52.3	52	56.5	64	69.5
Fair	40	43.4	38	41.3	26	28.2
Poor	4	4.3	2	2.2	2	2.2
7. Walking ability
Gr. IV	32	8.6	37	41.1	63	70.0
Gr. III	30	13.0	33	36.7	19	21.1
Gr. II	22	44.8	16	17.7	8	8.9
Gr. I	6	33.6	4	4.5	0	0

Variables	1st month		3rd month		6th month
	Mean	S.D.	Mean	S.D.	Mean	S.D.
1. WOMAC scores
Pain	5.3	1.2	2.8	1.4	1.4	0.9
Function	23	8.6	14	6.4	8	6.4
Stiffness	3.6	1.4	1.8	1	0.6	1.6
2. KSS
Knee score	73.2	16.8	82.4	12.7	8.2	10.2
Function score	62.8	14.9	74.3	15.2	82	7.5
3. 30 second chair test	4	2.1	5	1.8	6	1.2
4. VAS	4.8	1.4	3.8	1.1	2.6	0.6
5. CES D10	3.8	0.5	3.2	1.2	1.8	0.8
6. Friedmann–Wyman score	N	%	N	%	N	%
Good	54	60.0	58	64.5	72	80.0
Fair	33	36.6	30	33.3	16	17.3
Poor	3	3.3	2	2.2	2	2.2
7. Walking ability
Gr. IV	24	8.6	32	34.8	54	58.6
Gr. III	32	13.0	40	43.6	28	30.4
Gr. II	32	44.8	18	19.5	8	8.6
Gr. I	4	33.6	2	2.1	2	2.1

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E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: nishit palo@yahoo.com (S.K. Dash).

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Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty☆ ☆ Work performed in the centers in Bhubaneswar, Odisha, India.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

DISCUSSION:

CONCLUSION:

Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty^☆ ☆ Work performed in the centers in Bhubaneswar, Odisha, India.