Total Knee Replacement Results Around the WorldPatients in the United Kingdom, the United States, and Australia took part in this study on total knee replacements (TKRs). The researchers were interested in comparing how patients measure up before and after TKR. They wanted to see results from multiple centers in different countries.
Each patient was assessed before and after the operation. Follow-up measures were taken at three, 12, and 24 months after the TKR. Physical function, mental health, and general health were measured. A physical exam was carried out. The exam looked at walking ability, stair climbing, balance, motion, and strength.
Researchers found that patients who had more pain and less motion before surgery had the worst results afterwards. Patients in the United Kingdom had much worse results than patients in the United States or Australia.
The authors suggest differences in health care systems account for this finding. Patients in the United Kingdom were older and reported more pain than patients from other countries. They often had to wait up to a year to get on the surgery list. It was even longer before they had the operation. In the United Kingdom, patients are taken on a first-come, first-served basis rather than on severity of pain and loss of function.
Women in every country were worse off before surgery compared to men. Men and women had equal results after TKR. Patients with other health problems had less function after the operation. The authors think this is because they couldn't do the full rehab program. Poor mental health was also a predictor of poor outcome.
The authors conclude that knowing risk factors for a poor outcome after TKR can help doctors plan ahead. Patients with worse pain and function should have the TKR as early as possible. Patients with a possible poor outcome can be counseled ahead of time about what to expect. Pain and mental and physical function before surgery are the best predictors of results afterwards.
Elizabeth A. Lingard, BPHTY, MPHIL, MPH, et al. Predicting the Outcome of Total Knee Arthroplasty. In The Journal of Bone and Joint Surgery. October 2004. Vol. 86-A. No. 10. Pp. 2179-2186.
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