[Quality of life assessment one year after total hip or knee arthroplasty]

D Mainard, F Guillemin, C Cuny, E Mejat-Adler, L Galois, J Delagoutte
Revue de Chirurgie Orthopédique et Réparatrice de L'appareil Moteur 2000, 86 (5): 464-73

PURPOSE OF THE STUDY: The development of quality of life (QOL) instruments has made it possible to obtain an objective assessment of the impact of surgical procedures taking into consideration the physical, psychological and social aspects of the patient's everyday activities. The aim of this work was to evaluate the short-term and long-term course of QOL after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

MATERIALS AND METHODS: This study included a prospective multicentric cohort of patients with a first intention indication for degenerative bone and joint disease. Clinical assessment was obtained preoperatively and 6 weeks, 6 months and 12 months postoperatively. The Merle d'Aubigné and Harris scores were determined for THA and the Hospital Special Surgery score for TKA. Clinical data (pain, walking distance), and QOL scores [French version of the Nottingham Health Profile (NHP) and the French version of the Arthritis Impact Measurement Scale 2 (AIMS2)] were also obtained.

RESULTS: One hundred twenty-three patients had a THA (mean age 62 years) and 60 had a TKA (mean age 68 years). Preoperative clinical features were those commonly found in these populations. For THA, the 6-week, 6-month and 1-year assessments showed an improvement (2.7 and 2.8 points on the 0 to 10 NHP). For TKA, improvement came later and was less significant with 0.8, 1.8 and 1.5 point improvements. The AIMS 2 did not appear to be perfectly adapted to measure this dimension. Improvement in pain came earlier and was greater for THA than for TKA on all measurement scales. For THA, psychological capacity improved by 0.7, 1.4 and 1.5 points on the 0 to 10 AIMS 2 at 6 weeks, 6 months and 12 months respectively. For TKA, improvement was to the same order with 1.1 and 1.2 point improvements at 6 weeks and 6 months respectively.

DISCUSSION: These findings confirm the clear improvement in QOL after THA and TKA, mainly due to physical and psychological dimensions. The QOL measurements allow comparisons with other surgical procedures in other fields. They provide supplementary information, notably concerning pain and are particularly useful in orthopedic surgery. The questionnaires are generally well accepted by the patients, particularly short self-administered questionnaires. They provide useful information on the efficacy of THA and TKA in terms of human and social costs and open new perspectives for analysis of prognostic factors for optimal QOL of operated patients.

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