Patient satisfaction, function and return to work after knee arthroplasty

We investigated the working status during 2 years before and 2 years after primary knee prosthetic operation for arthrosis in order to identify preoperative factors predicting patient satisfaction, function and working capacity. 162 patients (86 women) younger than 60 years of age when operated on with a knee prosthesis during 1993 were studied. 91% of the patients returned a Nottingham Health Profile (NHP) questionnaire, and the Social Insurance Office could supply data on all patients.

There was a positive association between the duration of pre- and postoperative sick-leave in the patients who returned to work. Preoperative sick-leave longer than 180 days increased the risk of postoperative disability pension, which was not found to be influenced by the grade of the work. Among the 52 patients who returned to work postoperatively, all 6 NHP functional categories were better in the patients with less than 180 days of preoperative sick-leave than in the patients with more than 180 days of preoperative sick-leave. The overall patient satisfaction was greater among patients who went back to work postoperatively.

We conclude that long sick-leave before a knee prosthetic operation increases the risk of long postoperative sick-leave and disability pension and impairs the quality of life.     

Factors influencing return to work after aortocoronary bypass surgery.

Factors influencing the effect on employment status were investigated in 250 patients (males: females 224:26) who underwent coronary artery bypass surgery between March 1983 and November 1985. The median age at operation was 57.9 (range 36.6-69.4) years and the median follow-up time 32 (19-52) months. Preoperatively 149 patients (59.6%) were receiving sick pay or disability pension because of their heart disease. Only 64 (25.6%) were gainfully employed, in contrast to 97 (38.8%) at follow-up. Of those who were working at the time of operation, all but eight returned to work postoperatively. At follow-up 183 (80.3%) were free from symptoms or much improved, with degree of improvement somewhat greater in those who were working postoperatively. The period of sick leave and the preoperative waiting time were significantly shorter for patients who were working postoperatively than for those who were awarded disability pension. Age, previous myocardial infarction, duration of preoperative angina and type of work were also found to influence postoperative employment status.     

Duration of Disability Following Lumbar Disc Surgery

The total duration of disability of 116 patients operated on for lumbar disc prolapse was studied 10 years postoperatively. From the beginning of the observation period 10 years before surgery, the number of days on sick-leave increased continually and no positive effect of the surgical treatment in this respect could be observed. There was a highly significant coincidence between the end-result assessment by the patient and the total duration of the postoperative disability. The following factors were conducive to a short total period of postoperative disability: early surgery (short interval of preoperative sciatica), short total preoperative period of sick-leave and immediate relief of sciatic pain by the operation. The objective changes in the preoperative state of the patient such as neurological and X-ray findings had a less significant influence.     

Duration of Disability Following Lumbar Disc Surgery

The total duration of disability of 116 patients operated on for lumbar disc prolapse was studied 10 years postoperatively. From the beginning of the observation period 10 years before surgery, the number of days on sick-leave increased continually and no positive effect of the surgical treatment in this respect could be observed. There was a highly significant coincidence between the end-result assessment by the patient and the total duration of the postoperative disability. The following factors were conducive to a short total period of postoperative disability: early surgery (short interval of preoperative sciatica), short total preoperative period of sick-leave and immediate relief of sciatic pain by the operation. The objective changes in the preoperative state of the patient such as neurological and X-ray findings had a less significant influence.     

Duration of disability following lumbar disc surgery.

The total duration of disability of 116 patients operated on for lumbar disc prolapse was studied 10 years postoperatively. From the beginning of the observation period 10 years before surgery, the number of days on sick-leave increased continually and no positive effect of the surgical treatment in this respect could be observed. There was a highly significant coincidence between the end-result assessment by the patient and the total duration of the postoperative disability. The following factors were conducive to a short total period of post-operative disability: early surgery (short interval of preoperative sciatica), short total preoperative period of sick-leave and immediate relief of sciatic pain by the operation. The objective changes in the preoperative state of the patient such as neurological and X-ray findings had a less significant influence.     

Arthrodesis for chronic static scapholunate dissociation: a prospective study in 12 patients.

Twelve patients had limited arthrodesis between the scaphoid and the lunate for chronic static scapholunate dissociation using internal plate osteosynthesis. The median time between the injury and surgery was 50 months (range 9-180). They were followed up for a year postoperatively. Preoperative symptoms were pain, functional impairment, and restricted movement. During operation the scapholunate interosseous ligament was completely torn and the scaphoid malrotated in all patients. The range of motion was measured preoperatively and postoperatively, and the unaffected side used for control. For all patients except one postoperative extension, flexion, and radial deviation had considerably decreased. However, supination increased in seven of 12 patients postoperatively and so did pronation in seven of 12 patients. One patient (case 12) had an improved range of motion postoperatively in all directions. The mean grip strength was 76% of the unaffected side preoperatively, and has increased to 85% postoperatively. We found that bone healing was rare and most arthrodeses healed by a fibrous union. We found no correlation with preoperative arthrosis and clinical outcome. One patient had retired from work before operation because of back pain and one because of age. Two patients had taken early retirement because of wrist pain, and one patient was still on sick-leave at the follow-up a year postoperatively. Five patients returned to full-time work and two patients to part-time work. Four patients were on long-term sick-leave preoperatively and three of them returned to their previous occupations. Analysis of the patients' subjective outcome (including pain and functional scores) showed overall satisfaction, and objective data show that scapholunate arthrodesis for chronic static scapholunate dissociation provides substantial improvement over the preoperative condition.     

Duration of symptoms as a predictor of outcome after lumbar disc surgery

Summary Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated 1–3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. Patients with duration of the present attack of sciatica of less than 6 months had a significantly better result concerning outcome compared to patients with duration of 6–12 months and more than 12 months.Patients who returned to the same type of work had a pre-operatively statistically significant shorter duration of present sick-leave, compared to the patients who had changed the type of work and the patients who did not return to work.The patients with duration of their present sick-leave of less than 6 months had a significantly higher percentage of returning to the same type of work compared to patients with duration of their present sick-leave of 6–12 months and more than 12 months.We conclude that the duration of sciatica and sick-leave before the operation has value as predictive factors concerning the over-all result after surgery for lumbar disc herniation.     

Knee arthroplasty: are patients' expectations fulfilled?: A prospective study of pain and function in 102 patients with 5-year follow-up

Background and purpose With an aging population expecting an active life after retirement, patients’ expectations of improvement after surgery are also increasing. We analyzed the relationship between preoperative expectations and postoperative satisfaction and self-reported outcomes with regard to pain and physical function after knee arthroplasty.Patients and methods 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51–86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction, and relevance of the outcome to the patient. These investigations took place preoperatively and postoperatively after 6 months, 1 year, and 5 years of follow-up.Results Response rate at 5 years was 86%. In general, the patients’ preoperative expectations were higher than their postoperative ability. For example, 41% expected to be able to perform activities such as golfing and dancing while only 14% were capable of these activities at 5 years. Having high or low preoperative expectations with regard to walking ability or leisure-time activities had no influence on the KOOS scores postoperatively. 93% of the patients were generally satisfied 5 years postoperatively, while 87% were satisfied with the relief of pain and 80% with their improvement in physical function at that time.Interpretation With an expanding population of mentally alert elderly, we can expect that great demands will be put on joint replacements. This study shows that patients have high preoperative expectations concerning reduction of pain. To a considerable extent, these expectations are fulfilled after one year. Expectations concerning demanding physical activities are not fulfilled to the same degree; however, most patients reported general satisfaction with the outcome indicating that satisfaction is not equivalent to fulfilled expectations. Preoperative counseling should include realistic information on outcomes concerning physical function and pain relief.     

Life dissatisfaction is associated with a poorer surgery outcome and depression among lumbar spinal stenosis patients: a 2-year prospective study

The aim of this study was to examine the life satisfaction of lumbar spinal stenosis (LSS) patients up to the 2-year postoperative phase. Patients (N = 102, mean age, 62 years) with symptomatic LSS underwent decompressive surgery. Data collection took place with the same set of questionnaires before surgery and 3 months, 6 months, 1 year and 2 years postoperatively. Life satisfaction was assessed with the four-item Life Satisfaction scale and depression symptoms with the 21-item Beck Depression Inventory (BDI). In addition, a depression burden variable was included, comprising the sum of preoperative, 3- and 6-month BDI scores. Physical functioning and pain were assessed with the Oswestry disability index, Stucki questionnaire, self-reported walking ability, visual analogy scale and pain drawing. Two years postoperatively, 18% of the LSS patients was dissatisfied with their lives. As a whole, the life satisfaction of the LSS patients improved during the postoperative follow-up, reaching the level of the healthy adult Finnish population. However, 2 years postoperatively, dissatisfied patients reported significantly more pain, a poorer functional ability and more depressive symptoms and depression than the patients who were satisfied with life. This difference was seen throughout the postoperative follow up. In regression analyses, the only significant associations were between the depression burden and postoperative life dissatisfaction. Thus, subjective well-being as well as depression among LSS patients should be assessed pre- and postoperatively in order to enable early intervention for those at risk of poorer life satisfaction.     

Predictors of return to work after anterior cervical discectomy

Return to previous level of employment after surgery is important to patients. Predictors of return to work have been well described in lumbar disc surgery. However, this information cannot be generalized to the population undergoing cervical discectomy. The authors retrospectively reviewed 67 consecutive patients who underwent anterior cervical discectomy. Strict inclusion criteria were used. Baseline demographics were recorded as well as other potential predictors of postoperative return to work such as number of levels of disease, smoking history, and disability claims. Follow-up information about work status was reviewed with each patient at office visit. Forty-five patients were found eligible for the study. At a mean follow-up of 2.8 years (SD 1.4), 38% had not returned to work by 1 year. Preoperative sick leave in this group was significantly greater than for those patients who returned to work within the year (p = 0.0014). Postoperative neck pain was more common in individuals who did not return to work after surgery (p = 0.01). Increasing age and disability claims also appeared to negatively impact the ability to return to work. Gender, type of work, smoking history, and number of levels of disc disease did not appear to have any association with postoperative return to work. The authors conclude that the duration preoperative sick leave and postoperative neck pain negatively impact postoperative work status in patients undergoing anterior cervical discectomy. Age and disability claims also influence return to work.     

Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study

The aim of this study is to explore the occurrence and the risk factors of back-related loss of working time in patients undergoing surgery for lumbar disc herniation. One hundred and fifty-two gainfully employed patients underwent surgery for lumbar disc herniation. Two months postoperatively, those patients completed a self-report questionnaire including queries on back and leg pain (VAS), functional capacity (Oswestry disability index—ODI, version 1.0), and motivation to work. After 5 years, lost working time was evaluated by means of a postal questionnaire about sick leave and disability pensions. The cumulative number of back pain-related days-off work was calculated for each patient. All 152 patients, 86 men and 66 women, were prescribed sick leave for the first 2 months. Thereafter, 80 (53%) of them reported back pain-related sick leave or early retirement. A permanent work disability pension due to back problems was awarded to 15 (10%) patients, 5 men (6%) and 10 women (15%). Median number of all work disability days per year was 11 (interquartile range [IQR] 9–37); it was 9 days (IQR 9–22) in patients with minimal disability (ODI score 0–20) at 2 months postoperatively and 67 days (IQR 9–352) in those with moderate or severe disability (ODI > 20; P < 0.001). The respective means were 61, 29, and 140 days/year. Multivariate analysis showed ODI > 20, leg pain, and poor motivation to work to be the risk factors for extension of work disability. Results of the present study show that after the lumbar disc surgery, poor outcome in questionnaire measures the physical functioning (ODI) and leg pain at 2 months postoperatively, as well as poor motivation to work, are associated with the loss of working time. Patients with unfavourable prognosis should be directed to rehabilitation before the loss of employment.     

Patients are more satisfied than they expected after joint arthroplasty

The aim of this study was to compare the preoperative patients' expectations with their postoperative satisfaction after arthroplasties of the hip and knee, using a visual analogue scale. The comparison was made in a group of 44 patients after 44 primary knee and hip joint arthroplasties. A visual analogue scale (VAS) was used for the assessment of expectation and satisfaction. The mean preoperative expectation VAS was 14.8 (SD: 14.3). The mean patient satisfaction at time of follow up was 13.0 (SD : 21.1). We found no agreement in the preoperative patient's expectation satisfaction versus postoperative satisfaction (p = 0.66). Moreover in our study, the patients expected to be less satisfied than they actually were at follow-up, which is shown with the Bland and Altman method. It appears that patients are not capable of predicting the outcome of the joint arthroplasty, which could be influenced by negative preoperative information on complications and risks. Pain and functional disability are probably the most important factors for the patients' satisfaction after arthroplasty surgery.     

Occupational capacity after hip replacement

Working capacity and dependence on the social welfare system were analyzed in 387 patients 5 years after hip replacement. Significant pre-operative factors were age, etiology of the hip disease and walking ability, and at the follow-up age, walking ability, pain and subjective experience of satisfaction with the operation. Among patients working pre-operatively, 92 per cent kept on working, and 70 per cent of patients on sick-leave went back to work. Only 9 per cent of patients working or sick-listed pre-operatively became invalidity pensioners, but none who were pensioners pre-operatively went back to work.     

Patient demand matching in total knee arthroplasty: is it necessary?

Patient demand matching has been accepted as an appropriate method of implant management by hospitals for cost reduction. However, there have been no prospective studies to substantiate whether these patients change their demand levels postoperatively. Theoretically, functional activity levels should not increase significantly postoperatively in patients with preoperative low demand levels for patient demand matching to be effective in avoiding premature prosthetic failure. Preoperative and postoperative demand levels were prospectively reviewed in 279 patients undergoing total knee arthroplasty (TKA). Preoperatively, the medium/high-demand patients performed significantly more activities overall than low-demand patients. Postoperatively, both low- and medium/high-demand patients dramatically increased the number of activities performed. The hypothesis that prosthetic choice should be determined by preoperative activity level (demand matching) was not validated by this study because patient activity levels significantly increased in all categories subsequent to TKA.     

Results of reoperations for coronary artery disease

Seventy-one patients undergoing reoperation for coronary artery disease were examined on average 2.5 years postoperatively. Operative mortality was 9.9% and late mortality 6.3%. 88% of the patients improved subjectively, and although only 7.8% were angina-free, 79.9% were in NYHA Class I or II. All patients who had been working before reoperation returned to work, and either patients who were on sick-leave before resumed their activities. A follow-up examination was performed in 21 patients with a follow-up time of more than three years. The mean peak work capacity did not change after reoperation and also the ST changes during the bicycle ergometer exercise test were the same after reoperation. The mean ejection fraction diminished from 54 +/- 15.5% to 44.7 +/- 15.2%. In thallium perfusion studies areas of hypoperfusion were observed in 14 cases (67%). Coronary angiograms showed 3.0 +/- 1.0 patent anastomoses at the follow-up examination; 76% of the anastomoses performed in the reoperations were patent. It can be concluded that although the objective results of repeat myocardial revascularisation in this material are not optimal, the subjective improvement of the patients was satisfactory, and in the majority of cases reoperation ensures an acceptable quality of life for years.     

Occupational capacity after hip replacement

Working capacity and dependence on the social welfare system were analyzed in 387 patients 5 years after hip replacement. Significant pre-operative factors were age, etiology of the hip disease and walking ability, and at the follow-up age, walking ability, pain and subjective experience of satisfaction with the operation.

Among patients working pre-operatively, 92 per cent kept on working, and 70 per cent of patients on sick-leave went back to work. Only 9 per cent of patients working or sick-listed pre-operatively became invalidity pensioners, but none who were pensioners pre-operatively went back to work.     

Patient satisfaction after medial opening high tibial osteotomy and microfracture

High tibial osteotomy has become an accepted treatment for patients with varus degenerative arthritis of the knee. We sought to determine factors associated with patient satisfaction and functional outcome following medial opening wedge high tibial osteotomy for the degenerative varus knee. Sixty-one patients (14 women and 47 men) undergoing medial opening wedge osteotomy and chondral resurfacing procedure (microfracture) for medial knee pain, with minimum 2-year follow-up, were identified through our clinical database. Mean patient age was 52.2 years (range: 35-65 years). Thirty patients were treated with plate fixation, and 31 with distraction osteogenesis and external fixation. Nineteen patients had Outerbridge grade III or IV patellofemoral lesions at initial surgery. The mean preoperative Lysholm score of 49.9 improved postoperatively to 75.4 (P < .001). Mean satisfaction score was 7.6 (1 = not satisfied, 10 = very satisfied). Women showed a significantly higher improvement in Lysholm and satisfaction scores than men (P = .029, P = .034). A positive correlation was observed between satisfaction and postoperative Lysholm score (P < .001). The independent multivariate predictor of patient satisfaction was the postoperative Lysholm score. Medial opening wedge high tibial osteotomy is an efficacious surgical option for the treatment of the degenerative varus knee, as demonstrated by both patient satisfaction and functional outcome scores.     

Surgical treatment of lumbar spinal stenosis: Patients' postoperative disability and working capacity

Summary A total of 439 patients operated on for lumbar spinal stenosis during the period 1974–1987 was re-examinated and evaluated for working and functional capacity approximately 4 years after the decompressive surgery. The assessment of subjective disability was based on the Oswestry low-back pain questionnaire. The proportion of excellent-to-good outcomes was 62% (women 57%, men 65%). The ability to work before or after the operation and a history of no prior back surgery were variables predictive of a good outcome. Before the operation 86 patients were working, 223 patients were on sick leave, and 130 patients were retired. After the operation 52 of the employed patients and 70 of the unemployed patients returned to work. None of the retired patients returned to work. In logistic regression analysis the ability to work preoperatively, age under 50 years at the time of operation and the absence of prior back surgery predicted a postoperative ability to work. Our results suggest that more attention should be focussed on the diagnosis of spinal stenosis and on the timing of the operative intervention.     

肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝,男8例,女34例;年龄60～78岁,平均65岁,身体质量指数（BMI）33—52,平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练,延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点,使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前,术后ROM高于术前,差异均有统计学意义。所有指标在术后4周以后均有逐步改善,但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。