FORT LAUDERDALE, FLA. – The first 5-year follow-up study of pain and function after total knee replacement reveals a discrepancy between patients' expectations and their actual ability to engage in sports and recreational activities postoperatively, according to a presentation at the World Congress on Osteoarthritis.
Although patients have realistic expectations about their ability to perform activities of daily life after knee surgery, many are disappointed with their diminished capacity for recreational activities or sports at the 5-year mark, said Dr. Anna K. Nilsdotter, a researcher at Halmstad (Sweden) Central Hospital.
Researchers typically follow patients for just 12 months and record only the number of prosthesis failures. However, Dr. Nilsdotter said, “The best result for patients is after 1 year. Then it declines.
“I have done the same thing in hip replacement after 8 years with the same result,” she added. “Patients report maximum effect at 1 year.” Dr. Nilsdotter and her associates assessed 102 patients with primary osteoarthritis prior to total knee replacement and at 6 months, 1 year, and 5 years after surgery to determine their pain, function, and satisfaction. Using the Short Form-36 health survey and the Knee Injury and Osteoarthritis Outcome Score (KOOS), they evaluated pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life domains. The researchers also asked additional questions about physical activity levels, expectations, and satisfaction.
At baseline, the mean age of participants was 71 years, 62% were women, and 6% had bilateral operations. A total of 21% of patients had a history of surgery on their contralateral knee.
Nine patients died before the 5-year follow-up. Of the remaining patients, 61% reported improved function in activities of daily living. For example, patients rated their ability to walk on a scale of 1 to 6, ranging from a need for crutches to walking indoors and up to unlimited walking on uneven terrain. “As many as 39% of these patients expected unlimited walking ability on uneven ground postoperatively,” Dr. Nilsdotter said. Patients reported their best walking ability at 1 year–28% could walk on uneven ground, whereas at 5 years, 21% could do so.
A total of 96% of patients expected their daily activity levels to be “better or much better,” and 72% expected those same results for their ability to engage in sports and recreation, Dr. Nilsdotter said at the meeting, sponsored by the Osteoarthritis Research Society International. “Patients' expectations were generally higher than their postoperative abilities,” Dr. Nilsdotter noted.
The greatest disparity between expectations and abilities was seen in postoperative functionality for sports and recreation. For example, 41% expected to be able to dance or golf, but at 5 years only 14% reported being able to do so, she said.
Most patients, 93%, were generally satisfied with results at 5 years postoperatively, but only 33% were totally or quite satisfied with their level of ability for sports or recreation.