From Medscape Rheumatology > Viewpoints

Long-term Follow-up After Knee and Hip Replacements -- Do Patients Have a Good Quality of Life?

Kevin Deane, MD

Authors and Disclosures

Posted: 03/16/2010

Total Hip or Knee Replacement for Osteoarthritis: Mid- and Long-term Quality of Life

Rat AC, Guillemin F, Osnowycxz G, et al
Arthritis Care Res (Hoboken). 2010;62:54-62

Introduction

Total knee and hip arthroplasty (TKA and THA, respectively) for osteoarthritis (OA) are common procedures; however, long-term data on the success of these procedures is limited. These authors evaluated the quality of life (QOL) in cohorts of patients 3 and 10 years post joint replacement.

Study Summary

In this French study, QOL data were collected on 2 separate cohorts -- the first was enrolled in 1994 (10-year cohort, N = 221[89 responders]) and the other in 2003 (3-year cohort, N = 232 [195 responders]). Postoperative QOL outcomes were determined using a variety of validated multidimensional measures, and these outcomes were compared with age- and sex-adjusted QOL scores in a general population (controls). For both joint replacement cohorts, QOL responses for physical functioning were lower than controls. Also, in both surgical cohorts, increasing comorbidities and pain at sites distal to the replaced joint were associated with lower QOL scores. In the 10-year cohort, QOL scores for pain and mental health were lower than in controls. The authors concluded, based on lower QOL scores in the 10-year group, that benefits of THA or TKA may be time-limited. Also, they suggest that treating comorbidities and distal pain may have long-term benefits.

Viewpoint

Multiple prior studies have demonstrated improvements in QOL measures over 6-12 months, or longer, after THA/TKA, although pain and function scores may not be as good as controls, even within a year of surgery.^[1]This study, however, suggests that longer-term outcomes may not be as good, although certainly there may be many factors affecting long-term QOL in patients who underwent THA/TKA. It would be interesting to compare QOL scores over time from these patients vs scores from patients with a similar severity of OA who did not undergo joint replacement. Also, there may be technical differences in joint replacements performed in 1994 vs 2003 that would influence outcomes in this study, and it would be interesting to determine outcomes in cohorts whose joint replacements were done with similar surgical techniques and hardware.

Given the finding of comorbidities and distal pain influencing QOL, it would also be of interest to perform an intervention trial addressing the role of treating these factors in improving long-term outcomes of THA and TKA. With universally aging populations potentially increasing the number of joint replacements performed as well as longer postoperative duration of joint replacements, these will be important issues to address. Until these studies are done, a take-home point from this article may be to maximize treatment of comorbidities. As the baseline body mass index for patients in each of these cohorts was 28-30, weight loss may be a major target for intervention.