Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group Health-related quality of life and appropriateness of knee or hip joint replacement. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients Joint Recovery Programme Versus Usual Care: An Economic Evaluation of a Clinical Pathway for Joint Replacement Surgery
OBJECTIVE To compare the health-related quality of life of people with osteoarthritis before and after primary total hip and knee replacement surgery  with that of the general Australian population . DESIGN A prospect i ve cohort study . SETTING Three Sydney hospitals , public and private . PARTICIPANTS Patients with osteoarthritis undergoing primary total hip ( n = 59 ) and knee ( n = 92 ) joint replacement surgery .  MAIN OUTCOME MEASURE Medical Outcomes Study Short Form ( SF-36 ) scores before and 12 months after joint replacement surgery ( compared with population norms ) . RESULTS Patients in each age group showed a significant improvement in health-related quality of life after joint replacement surgery in most scales of the SF-36 , particularly physical function , role physical and bodily pain . SF-36 scores for the 42 hip-replacement patients aged 55 - 74 years improved to equal or exceed the population norm on all scales . SF-36 scores of the 52 knee replacement patients aged 55 - 74 years improved , but physical function and bodily pain scores remained significantly worse than the population norm . SF-36 scores for both hip ( n = 17 ) and knee ( n = 40 ) replacement patients aged 75 years and over improved significantly , becoming similar to population norms for this age group . CONCLUSIONS Total hip or knee replacement for osteoarthritis significantly improves patient health and well-being at 12 months after surgery . Age alone should not be a barrier to surgery OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population Objective To assess health-related quality of life ( HRQOL ) in a prospect i ve study with 7 years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis . Methods Generic HRQOL was assessed with the  short-form 36 ( SF-36 ) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results Out of the 39 subjects who have completed the 7 years of follow-up of this study , 22 ( 56.4 % ) underwent a hip replacement surgery and the other 17 ( 43.6 % ) a knee replacement . Six months after surgery , a significant improvement , compared to preoperative scores , was observed in two of the eight dimensions of the SF-36 ( i.e. physical function and pain ) . The same dimensions , pain and physical function , at the same time , 6 months after surgery , measured by the WOMAC , showed a significant improvement as well , but there was no significant change in the stiffness score . From 6 months to the end of follow-up , changes in SF-36 scores showed a significant improvement in physical function ( p = 0.008 ) , role-physical ( p = 0.004 ) and role-emotional ( p = 0.01 ) while all scores of the WOMAC improved ( p < 0.001 for pain , p < 0.001 for stiffness and p < 0.01 for physical function ) . Conclusion The improvements observed in HRQOL at short term after surgery , are at least maintained over a 7-year follow-up period Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response Objective . To define pain and physical function cutpoints that would , coupled with structural severity , define a surrogate measure of “ need for joint replacement surgery , ” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis ( OA ) . Methods . New scores were developed for pain and physical function in knee and hip OA . A cross-sectional international study in 1909 patients was conducted to define data -driven cutpoints corresponding to the orthopedic surgeons ’ indication for joint replacement . A post hoc analysis of 8 r and omized clinical trials ( 1379 patients ) evaluated the prevalence and validity of cutpoints , among patients with symptomatic hip/knee OA . Results . In the international cross-sectional study , there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement ; indeed , it was not possible to determine cutpoints for pain and function defining this indication . The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression , high level of pain , and high degree of function impairment was low ( 2%–12 % ) . The most discriminatory cutpoint to define an indication for joint replacement was found to be [ pain ( 0–100 ) + physical function ( 0–100 ) > 80 ] . Conclusion . These results do not support a specific level of pain or function that defines an indication for joint replacement . However , a tentative cutpoint for pain and physical function levels is proposed for further evaluation . Potentially , this symptom level , coupled with radiographic progression , could be used to define “ nonresponders ” to disease-modifying drugs in OA clinical trials BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants Background Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes . However , some people experience long-term pain . Objectives To review published studies in representative population s with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity . Data sources MEDLINE and EMBASE data bases search ed to January 2011 with no language restrictions . Citations of key articles in ISI Web of Science and reference lists were checked . Study eligibility criteria , participants and interventions Prospect i ve studies of consecutive , unselected osteoarthritis patients representative of the primary total hip or knee replacement population , with intensities of patient-centred pain measured after 3 months to 5-year follow-up . Study appraisal and synthesis methods Two authors screened titles and abstract s. Data extracted by one author were checked independently against original articles by a second . For each study , the authors summarised the proportions of people with different severities of pain in the operated joint . Results Search es identified 1308 articles of which 115 reported patient-centred pain outcomes .  Fourteen articles describing 17 cohorts ( 6 with hip and 11 with knee replacement ) presented appropriate data on pain intensity . The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7 % to 23 % after hip and 10 % to 34 % after knee replacement . In the best quality studies , an unfavourable pain outcome was reported in 9 % or more of patients after hip and about 20 % of patients after knee replacement . Limitations Other studies reported mean values of pain outcomes . These and routine clinical studies are potential sources of relevant data . Conclusions and implication s of key findings After hip and knee replacement , a significant proportion of people have painful joints . There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes Objective : The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement , the Joint Recovery Programme ( JRP )  , as compared with usual care . The existing care process was revised to contain costs and shorten waiting lists by facilitating patient flows and improve healthcare efficiency . Methods : The study design was a before – after trial . In total , 160 patients undergoing total hip and total knee replacement , aged 28 to 87 years ( mean age , 64.4 years ) , were treated either according to the Joint Recovery Programme ( a st and ardized care process with patient education and rehabilitation in groups ) or usual care . Both groups were followed for 1 year . Costs were studied from a societal perspective . Outcomes included functional level ( Harris Hip score and American Knee Society score ) and generic quality of life ( EuroQol ) . Results : The results indicate that the Joint Recovery Programme result ed in a significant cost saving when compared with usual care mainly as a result of a considerable ( > 50 % ) reduction in length of hospital stay . The average cost saving per patient amounted to $ 1261 in the total hip replacement group and $ 3336 in the total knee replacement group . At the same time , both functional level and quality of life were higher in the JRP group . Conclusions : Clinical pathway dominates usual care and is a highly cost-effective approach to contain costs related to joint replacement surgery without adverse consequences for patients
Physical activity did not change at 6 months , and a small to moderate improvement was found at 12 months postsurgery , despite large improvements in quality of life , pain , and physical function .
Reasons for the lack of increased PA are unknown but may be behavioral in nature , as a sedentary lifestyle is difficult to change .
OBJECTIVE Little is known about the extent to which  physical activity ( PA )  levels change following total knee or hip joint replacement relative to pain , physical function , and quality of life .
Our objective was to conduct a systematic review and meta- analysis on changes in PA relative to pain , quality of life , and physical function  after total knee or hip joint replacement .