Comparison of short-term SF-36 results between total joint arthroplasty and cervical spine decompression and fusion or arthroplasty.

STUDY DESIGN: Cohort comparison of results of meta-analysis.

OBJECTIVE: To compare improvement in SF-36 after cervical spine surgery to total hip and joint arthroplasty.

SUMMARY OF BACKGROUND DATA: Health-related quality of life outcome instruments allow comparison of different diseases and change with various treatments. Total hip and knee arthroplasty are accepted procedures with excellent outcomes. It is unknown if treatment of cervical spine disease approaches those results.

METHODS: A meta-analysis of SF-36 outcomes of total hip and knee arthroplasty was performed and compared to results after cervical discectomy and arthroplasty or fusion. Pooled means and SD were calculated and compared among treatment groups using analysis of variance.

RESULTS: Eighteen studies reporting results in patients having total hip and knee arthroplasty and 2 randomized controlled studies of cervical disc arthroplasty were identified. The baseline physical function was worse in the joint arthroplasty patients and the mental health scores were worse in the cervical spine patients. The mean improvements in PCS for disc, fusion, total hip, and total knee arthroplasty were 14.2, 12.5, 12.2, and 9.6, respectively. The improvement in the physical component score (SF-36) was significantly greater in the cervical arthroplasty compared to the other 3 groups. Cervical fusion improvement was similar to total hip arthroplasty and both were greater than total knee arthroplasty. MCS domain improvement was significantly better in the cervical spine groups.

CONCLUSION: The SF-36 results were surprising and showed equal or greater short-term improvement in cervical spine patient's pain and function than that observed after joint arthroplasty, although all groups had substantial improvement. Greater MCS improvement was likely caused by a ceiling effect as joint arthroplasty on average had normal scores at baseline.