The importance of patient expectations in predicting functional outcomes after total joint arthroplasty

OBJECTIVE: To evaluate the relationship between patient expectations of total joint arthroplasty (TJA) and health related quality of life plus satisfaction 6 months after surgery. Methods. This prospective cohort study included patients undergoing primary total hip (THA) and knee arthroplasty (TKA). Patients were evaluated with self-report questionnaires prior to surgery and 6 months post-surgery. Medical Outcomes Study Short Form 36 (SF-36), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and a satisfaction scale were used to evaluate outcomes at final followup. Multivariate regression models were used to evaluate the impact of expectations on outcomes. RESULTS: There were 102 patients with THA and 89 with TKA. Mean age was 66 years. All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery. Patient expectations regarding surgery were not associated with their age, gender, index joint of surgery, marital status, or race. Expectations were not correlated with pre-operative functional health status. Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery. Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction. CONCLUSIONS: Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA. Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA.     

Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty

OBJECTIVE: To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty. METHODS: A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6-week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery. RESULTS: Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P = 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P = 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074-0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively. CONCLUSION: A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.     

Serum Gliostatin Levels in Patients with Rheumatoid Factor-Negative and -Positive Rheumatoid Arthritis and Changes of these Levels after Surgical Treatments

Gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF) has a potential for arthritogenic action. The aim of this study was to examine whether measurement of serum GLS can be used to evaluate symptomatic improvements after surgery (arthroplasty or synovectomy) as well as the aggressiveness of disease activity in rheumatoid arthritis (RA). Serum GLS levels were determined by enzyme immunoassay in rheumatoid factor (RF)-positive and -negative RA patients. In those undergoing surgery, levels were measured 3 months before and after the operations. Both RF-positive and -negative RA sera showed higher GLS levels than normal and osteoarthritis sera. Patients undergoing arthroplasty demonstrated a decrease in serum GLS levels after the operations, but patients undergoing synovectomy did not, reflecting the extent of remaining or reproliferating synovial tissues rich in GLS production. These findings suggest that the serum GLS level is a useful indicator for evaluation of synovitis and the systemic efficacy of surgical treatment. Received: 19 June 2000 / Accepted: 31 March 2001     

Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study

OBJECTIVE: To determine if physical activity was a risk factor for revision arthroplasty after primary total knee arthroplasty (TKA) due to osteoarthritis (OA) within the previous 15 years. METHODS: This was a matched case-control study. The cases had primary TKA followed by revision arthroplasty. Controls had primary TKA and no revision arthroplasty. Cases and controls were matched for age, sex, number of knees replaced, and date of primary TKA. Standardized telephone interviews were conducted to assess historical leisure activity, occupational activity, and instrumental activities of daily living after primary TKA in metabolic equivalent (MET)-hours per week. Conditional logistic regression was performed to identify the variables that predicted the need for revision arthroplasty. RESULTS: Seventeen female and 9 male pairs, aged 47 to 85 years, participated. Most of the reported activity was of low impact and low or moderate intensity. Cases reported a median of 44.5 (range 0 to 137) MET-hours of total historical physical activity per week compared with controls' 55.1 (range 0 to 278) MET-hours. Total historical physical activity was not associated with the risk of revision arthroplasty (OR 0.99, 95% CI 0.99-1.01). Participants with primary TKA (controls) consistently reported more MET-hours of leisure and occupational activity than those with revision arthroplasty (cases) regardless of the number of knees replaced or whether or not walking was accounted for. CONCLUSION: This study quantified and described patterns of physical activity in a population with TKA. Physical activity did not appear to be a risk factor for revision arthroplasty. Our results suggest that individuals undergoing primary TKA should be encouraged to remain active after surgery.     

The risk of contralateral total knee arthroplasty after knee replacement for osteoarthritis

OBJECTIVE: Osteoarthritis (OA) is the most common indication for total knee arthroplasty (TKA), but the rate of contralateral disease progression after unilateral TKA as well as risk factors that may predict progression have not been determined. We assessed the overall rate of contralateral knee replacement after initial TKA for OA as a marker of progression to advanced symptomatic OA. METHODS: A total of 117 consecutive patients undergoing unilateral TKA for OA between 1983 and 1988 were evaluated and followed longitudinally for up to 14 years. Evaluation of potential risk factors for progression to contralateral TKA included age, sex, side of surgery, body mass index (BMI), and Kellgren-Lawrence (K-L) grade. RESULTS: The contralateral knee progressed to TKA in 31 patients, yielding an overall 10-year risk of contralateral TKA of 37.2%. The baseline K-L grade of the contralateral knee was strongly correlated with future risk of TKA (p < 0.001). Mean survival times were similar for those with grade II (131.7 mo) and grade III (127.6 mo); patients with grade IV, however, had a mean survival of 80.5 months, with an overall 10-year risk of TKA of 62.7%. Age, sex, side of initial TKA, and BMI were not risk factors for progression to contralateral TKA. CONCLUSION: In this cohort, the K-L grading scale was a highly significant predictor for progression of contralateral OA to TKA. These data may provide important information to patients undergoing TKA, and shed light on the natural history of contralateral OA after TKA.     

Deep venous thrombosis was not detected after total knee arthroplasty in Japanese patients with haemophilia

Combined thrombo‐prophylaxis with mechanical and pharmacological methods is recommended in patients undergoing total knee or hip arthroplasty. As patients with ‘untreated inherited bleeding disorders such as haemophilia’ are at risk of bleeding, no prophylaxis has been prescribed for these patients. However, a retrospective study reported subclinical deep venous thrombosis (DVT) in 10% of patients with haemophilia undergoing major orthopaedic surgery. In this study, we aimed to evaluate the risk of DVT after total knee arthroplasty (TKA). We examined 38 TKA in 33 Japanese patients with haemophilia using ultrasonography. We did not detect DVT. The risk of DVT in patients with haemophilia after TKA may be lower than that in the general population. However, as patients with haemophilia progress in age, venous thromboembolism should be considered as a potential problem.     

Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life

Abstract

Though excellent clinical results have been reported for total joint arthroplasty (TJA) in rheumatoid arthritis (RA) patients, the longitudinal effects of TJA on pain, physical function, and health-related quality of life in RA patients remain unknown. This study aimed to assess changes in disease activity and health-related quality of life after TJA in patients with established RA. We analyzed the effect of total knee arthroplasty (TKA) and total hip arthroplasty (THA) on RA disease activity in an observational cohort of RA patients. Of the registered RA patients, 333 TKA and 77 THA patients were followed for 5 years after surgery. RA disease activity and health-related quality of life were measured using the Disease Activity Score 28 (DAS28) and a Japanese version of the Stanford health assessment questionnaire (J-HAQ). The mean DAS28 in TKA patients decreased from 4.66 (preoperatively) to 4.02 (3 years postoperatively) and to 3.94 (5 years postoperatively); the mean DAS28 in THA patients decreased from 4.41 (preoperatively) to 3.99 (3 years postoperatively) and to 3.92 (5 years postoperatively). The mean J-HAQ for TKA remained essentially unchanged, ranging from 1.48 (preoperatively) to 1.45 (3 years postoperatively) and to 1.47 (5 years postoperatively); the mean J-HAQ for THA also remained unchanged, ranging from 1.74 (preoperatively) to 1.74 (3 years postoperatively) and to 1.73 (5 years postoperatively). Of the total J-HAQ score, the lower limb score improved while the upper limb score worsened. Although TKA and THA improve clinical outcomes in damaged knees and hips and have a positive secondary systemic effect on RA disease activity, they have not had a continuously good effect on the measures of health-related quality of life. We conclude that tight control of RA disease activity is indicated for those patients with TKA and/or THA.     

Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life

Though excellent clinical results have been reported for total joint arthroplasty (TJA) in rheumatoid arthritis (RA) patients, the longitudinal effects of TJA on pain, physical function, and health-related quality of life in RA patients remain unknown. This study aimed to assess changes in disease activity and health-related quality of life after TJA in patients with established RA. We analyzed the effect of total knee arthroplasty (TKA) and total hip arthroplasty (THA) on RA disease activity in an observational cohort of RA patients. Of the registered RA patients, 333 TKA and 77 THA patients were followed for 5?years after surgery. RA disease activity and health-related quality of life were measured using the Disease Activity Score 28 (DAS28) and a Japanese version of the Stanford health assessment questionnaire (J-HAQ). The mean DAS28 in TKA patients decreased from 4.66 (preoperatively) to 4.02 (3?years postoperatively) and to 3.94 (5?years postoperatively); the mean DAS28 in THA patients decreased from 4.41 (preoperatively) to 3.99 (3?years postoperatively) and to 3.92 (5?years postoperatively). The mean J-HAQ for TKA remained essentially unchanged, ranging from 1.48 (preoperatively) to 1.45 (3?years postoperatively) and to 1.47 (5?years postoperatively); the mean J-HAQ for THA also remained unchanged, ranging from 1.74 (preoperatively) to 1.74 (3?years postoperatively) and to 1.73 (5?years postoperatively). Of the total J-HAQ score, the lower limb score improved while the upper limb score worsened. Although TKA and THA improve clinical outcomes in damaged knees and hips and have a positive secondary systemic effect on RA disease activity, they have not had a continuously good effect on the measures of health-related quality of life. We conclude that tight control of RA disease activity is indicated for those patients with TKA and/or THA.     

Pre-operative flexion contracture determines the functional outcome of haemophilic arthropathy treated with total knee arthroplasty

End-stage haemophiliac arthropathy can be successfully treated with total knee arthroplasty. However, the functional results may not be as good as anticipated and certain pre-op knee characteristics may alter the functional results. The purpose of this study was to evaluate the functional outcome of TKA in haemophilic patients with specific attention to final range of motion and residual flexion contracture of the joint. Twenty-one consecutive patients were retrospectively reviewed. The average age was 34 years with an average follow-up of 5.7 years. Functional status was evaluated with Hospital for Special Surgery Knee Score. Receiving Operating Characteristics analysis was used to determine the threshold of pre-operative flexion contracture degree to avoid residual knee contracture. The range of motion was increased in 16 joints and unchanged in three joints and decreased in the remaining two. Preoperative average range of motion was 37.6°, improved to 57.1° post-operatively. The average knee score increased from 27.85 (15-30) points pre-operatively to 79.42 (12-94) points at the last follow-up. The degree of pre-operative flexion contracture was found to be a good predictor for residual flexion contracture. (Specificity: 85.7%, sensitivity: 100%, cut-off: 27.5°). Total knee replacement improves the quality of life in patients with advanced haemophilic arthropathy. Statistical analysis revealed that pre-op flexion contracture of 27.5° is an important threshold. Patients should be operated before that stage to gain maximum benefit with minimal gait abnormalities.     

Local Deposition of Calcium Pyrophosphate Crystals in Evolution of Knee Osteoarthritis

The aim of the study was to investigate the frequency of development of local calcium pyrophosphate (CPPD) crystal deposition in patients with knee OA initially found negative for these crystals, as well as to discover whether prognostic indicators for this subset of patients can be found. A clinical follow-up of records of outpatients with idiopathic knee OA was established. An anteroposterior plain radiography of the knee joints was made initially and at the end of the observation period. The follow-up period needed to be more than 1 year. Patients were divided into two groups. The first included patients with knee OA who did not develop intra-articular CPPD crystal deposition during the observation period (OA group). The second included those patients whose X-rays or synovial fluid (SF) analysis in the follow-up showed these crystal deposits to be present (OA + CPPD group). There were 59 patients (42 women, 17 men) who met the selection criteria. During the observation period (8.1 ± 7.4 years in the OA group, 10.4 ± 6 years in the OA + CPPD group), intra-articular CPPD deposits were observed in 15 patients (25%): 10 on the X-rays, eight in the SF and three in both examinations. Age at diagnosis of OA and incidence of obesity were similar in both groups. There was a trend (P= 0.21) towards men developing intra-articular CPPD crystal deposits more frequently than women. OA in only one knee joint was significantly more frequent in the group with CPPD (P<0.01). Of those with CPPD deposits 40% required surgery at the end of the observation period, compared to 27.2% of those without deposits (P= 0.27). The waiting period before knee surgery was shorter in the OA + CPPD group but the difference was not statistically significant. In conclusion, local CPPD crystal deposition was observed in 25% of cases during the evolution of knee OA. No predictive factors were found. OA of the knee could, per se, favour the development of CPPD deposits. The occurrence of intra-articular CPPD deposits seemed to be related to a more rapid and severe evolution of OA of the knee. Received: 25 October 2000 / Accepted: 18 June 2001     

Self-perceived distress and self-perceived functional recovery after recent total hip and knee arthroplasty

The research was aimed at verifying whether psychological distress and depression are associated to reduced functional improvement following arthroplasty. Thirty-six patients with total knee arthroplasty (TKA) and 36 patients total hip arthroplasty (THA) were enrolled at the beginning of their rehabilitation. The mean age in TKA patients was 71.3+/-7.8 years (S.D.). The mean age in THA patients was 67.9+/-8.4 years. The Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC) and the Hospital Anxiety and Depression (HAD) were applied. Forty-four percent of THA and 58% of TKA showed over-threshold HAD scores at admission. The proportion was even higher considering HAD-Depression sub-scale, where 55% of THA and 61% of TKA patients had over-threshold scores. Lack of depression prompted better functional outcome in TKA. The effect of depression on TKA functional improvement was still significant after adjusting for age and sex. No association was found for THA patients. In order to maximize rehabilitation benefit it is then suggested that patients with recent TKA intervention are screened for distress and depression at admission and that psychological symptoms are treated if over-threshold.     

CLINHAQ Scale – Validation of a Hebrew Version in Patients with Fibromyalgia

Assessment of health status in patients with rheumatic disease, including fibromyalgia (FM), using structured questionnaires has become an important approach to evaluate treatment and outcome. The objectives of this study were to validate a translated version of the Clinical Health Assessment Questionnaire (CLINHAQ) to be used by Hebrew-speaking populations, and specifically to evaluate its usefulness in fibromyalgia syndrome (FM). The CLINHAQ was translated into Hebrew and administered to 90 women with FM along with the Hebrew versions of the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life (QOL) Scale. The CLINHAQ includes scales of functional disability, helplessness, anxiety and depression, as well as assessment of current health status and satisfaction with this. All subjects were asked about the presence and severity (assessed by visual analogue scale) of current FM symptoms (pain, fatigue, anxiety etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were measured by dolorimetry. Test–retest reliability was assessed by Pearson correlation coefficients, and internal consistency was evaluated with Cronbach’s α coefficient of reliability. Construct validity was tested by correlating the CLINHAQ items with measures of symptom severity, count of tender point, tenderness thresholds, physical functioning measured by FIQ, and with a score of QOL. Test–retest reliability coefficients ranged from 0.82 to 0.99, and Cronbach’s α coefficients from 0.725 to 0.929. Significant moderate to high correlations were obtained between most subscales of CLINHAQ and measures of physical functioning, quality of life and severity of FM symptoms. In conclusion, the CLINHAQ is a reliable and valid instrument for measuring health status and physical functioning in Israeli women with FM. Received: 22 June 1999 / Accepted: 24 September 1999     

Evaluation of analgesic effect,joint function recovery and safety of meloxicam in knee osteoarthritis patients who receive total knee arthroplasty: A randomized,controlled, double-blind study

Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.     

Preoperative autologous blood donation in primary total knee arthroplasty: a single-centre experience on 214 consecutive patients

BACKGROUND AND OBJECTIVES: Although preoperative autologous blood donation (PABD) is a widespread practice in elective orthopedic surgery, it is controversial whether this procedure avoids allogeneic blood transfusions in patients undergoing total knee arthroplasty (TKA). PATIENTS AND METHODS: We performed a retrospective study on 214 consecutive patients undergoing PABD before elective primary TKA. RESULTS: Thirty-eight patients (17.8%) were transfused with autologous red blood cells (RBC), while four of them (10.5% of those requiring transfusions, 1.9% of all patients) also received allogeneic RBC. The transfused patients were, in most cases, female and had significantly lower basal and preoperative haemoglobin levels. CONCLUSIONS: Based on the results of this study, PABD is not necessary in most patients undergoing TKA, although older female patients with low basal haemoglobin levels could benefit from a predeposit programme and/or erythropoietin support in order to reduce the risk of exposure to allogeneic blood.     

Why do Patients with Rheumatoid Arthritis use Alternative Treatments?

The aim of this study was to analyse the characteristics of patients with rheumatoid arthritis (RA) who make use of alternative or complementary medicine (CM). Two hundred and sixty-two randomly chosen patients with RA filled out self-assessment health status and pain questionnaires. Differences between the group of patients making use of both CM and conventional treatment (n = 52) and the group of patients who relied only on conventional treatment prescribed by their rheumatologists (n = 210) were explored with respect to demographic characteristics, duration of RA, levels of physical, psychological and social functioning, and pain-coping behaviour. We found that female patients used CM more often than did male patients, and those who used CM were younger than those who did not. There were no differences with respect to duration of RA, physical, psychological or social functioning or pain coping; however, the perceived impact of RA on several domains of life was higher in patients who used CM than in those who did not. Nevertheless, the patient groups did not differ in terms of medical consumption, except that those who used CM visited medical specialists for RA-related complaints less than those who relied only on conventional treatments. We concluded that the higher impact of RA, in the absence of worse disease, perceived by users of CM in several domains of life, especially psychosocial functioning, could be the reason they use CM. This suggests that CM cannot be substituted by additional conventional treatment prescribed by the rheumatologist, but rather by psychosocial intervention. Received: 10 June 2000 / Accepted: 25 October 2000     

The Outcome of Knee Synovitis in Early Arthritis Provides Guidelines for Management

The aim of the study was to examine the clinical outcome of patients presenting to an early arthritis clinic with synovitis of the knee. The patients were assessed at presentation for evidence and pattern of joint inflammation. These patients were then reassessed at 3, 6 and 12 months and thereafter annually to determine clinical outcome. One thousand six hundred and thirty-three consecutive referrals were examined, 903 of whom had early synovitis. One hundred and thirty had knee synovitis at presentation, of whom 73 fulfilled ACR criteria for rheumatoid arthritis (RA) during the study. All 73 presented with a symmetrical polyarthritis that included the small joints and had persistent disease at 1 year. Of the remaining 57 patients, 61% of those presenting with an oligoarthritis and 33% with a polyarthritis (including knee synovitis) were in remission at 1 year. None of those presenting as a monoarthritis of the knee had inflammation at 1 year or fulfilled ACR criteria for RA at any time. It was concluded that patients presenting with knee synovitis in the absence of a small joint polyarthritis usually have a benign course following standard therapy. No patient who presented with monoarthritis developed RA. Knee synovitis as part of a polyarthritis (even when not fulfilling ACR criteria) probably justifies disease-modifying antirheumatic drug at presentation. Received: 11 March 1999 / Accepted: 26 July 1999     

The effect of age on pain, function, and quality of life after total hip and knee arthroplasty

BACKGROUND: As utilization rates for total joint arthroplasty increase, there is a hesitancy to perform this surgery on very old patients. The objective of this prospective study was to compare pain, functional, and health-related quality-of-life outcomes after total hip and total knee arthroplasty in an older patient group (> or =80 years) and a representative younger patient group (55-79 years). METHODS: In an inception community-based cohort within a Canadian health care system, 454 patients who received primary total hip arthroplasty (n = 197) or total knee arthroplasty (n = 257) were evaluated within a month prior to surgery and 6 months postoperatively. Pain, function, and health-related quality of life were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the 36-Item Short-Form Health Survey (SF-36). RESULTS: There were no age-related differences in joint pain, function, or quality-of-life measures preoperatively or 6 months postoperatively. Furthermore, after adjusting for potential confounding effects, age was not a significant determinant of pain or function. Although those in the older and younger groups had comparable numbers of comorbid conditions and complications, those in the older group were more likely to be transferred to a rehabilitation facility than younger patients. Regardless of age, patients did not achieve comparable overall physical health when matched with the general population for age and sex. CONCLUSIONS: With increasing life expectancy and elective surgery improving quality of life, age alone is not a factor that affects the outcome of joint arthroplasty and should not be a limiting factor when considering who should receive this surgery.     

Prevalence of total knee arthroplasty and its predictive factors in Japanese patients with rheumatoid arthritis: Analysis using the NinJa cohort

Objectives. The aim of this study was to clarify the prevalence and the predictive factors for undergoing total knee arthroplasty (TKA) among patients with rheumatoid arthritis (RA).

Methods. The data of 1,134 patients with RA who were enrolled in the Japanese nationwide cohort database NinJa in 2003 and consecutively followed up until 2009 were analyzed.

Results. Seventy-six patients underwent TKA during the observation period. The yearly progression of the modified Health Assessment Questionnaire or mHAQ score from 2003 to 2004, but not the yearly progression of the Disease Activity Score in 28 Joints or DAS28 or patient visual analog scale (VAS) score, was significantly higher in the patients who underwent TKA than those who did not.

Multivariate analysis showed that knee involvement in the disease, high Steinbrocker stage (III or IV), and high patient VAS score at the time of enrollment were powerful predictive factors, with hazard ratios of 4.01, 3.71, and 1.20, respectively.

According to survival analysis with TKA as an endpoint, patients with knee involvement in the disease at the time of enrollment had a significantly worse 5-year survival rate than did those without knee involvement (83.5% vs. 97.0%, respectively).

Conclusion. Several factors were elucidated as predictive factors for undergoing TKA among patients with RA.     

Outcomes of knee arthrodesis following infected total knee arthroplasty: a retrospective analysis of 8 cases

Abstract

Background. There is insufficient information regarding patient-based outcomes after knee arthrodesis following infected total knee arthroplasty (TKA). The purpose of this study was to analyze outcomes in patients who underwent knee arthrodesis following infected TKA using clinical and radiographic measurements including a patient-based outcome measuring system.

Methods. We evaluated 8 patients (mean age 72.9 years) who were followed for more than 3 years after arthrodesis. Clinical and radiographic evaluation was performed, including examination of the patient’s function and use of supportive equipment for walking. The Japanese knee osteoarthritis measurement (JKOM) was used for measuring patient-based outcomes and health-related quality of life.

Result. Knee fusion was achieved in 7 patients. The mean limb-length discrepancy was 5.4 cm. All patients could walk at least inside the house, and activity of daily living (ADL) independence was achieved by the patients with successful knee fusion, although walking aids, including a shoe lift causing little discomfort, were required. The results of JKOM for the patients with successful fusion were comparable to the data for patients who underwent TKA.

Conclusions. When knee arthrodesis was performed for infected TKA cases, pain was reduced and ADL independence was established when knee fusion was achieved. This study demonstrated that information from subjective and functional evaluations of knee arthrodesis patients is useful in understanding postoperative activity and situations, and revealed the importance of supportive elements for walking.     

Indications of total ankle arthroplasty for rheumatoid arthritis: evaluation at 5 years or more after the operation

 The postoperative results of total ankle arthroplasty (TAA) were surveyed, and the indications of TAA for rheumatoid arthritis (RA) were examined. We have performed TAA in properly selected patients with indication of ankle joint destruction due to RA. The subjects were 18 RA patients (20 joints) who underwent TAA between April 1988 and April 1996. Type-ND or type-TNK Bioceram was used without cement for possible revision of TAA. No destruction of large joints was found in 8 patients, and TAA was used as part of multiple arthroplasty in 10 patients. After the operation, decrease in or disappearance of joint pain was obtained, and range of motion and improved ability to walk were secured. The clinical results were superior to those obtained for 17 joints of 17 patients who underwent ankle arthrodesis during the same period. However, a radiolucent zone was observed an X-ray examination in every case, after 8 years on average (range 5–12 years) after operation. Under present conditions, ankle arthrodesis should be used for younger patients. When no destruction of the hip or knee joint is found and the patient is 65 years of age or older, we believe TAA is indicated. In cases of multiple arthroplasty or with bilateral ankle joint destruction, TAA appears to be useful if patients are young, considering their better life expectancy and quality of life. Received: April 30, 2002 / Accepted: August 26, 2002