Aileen M Davis1, Selahadin Ibrahim2, Sheilah Hogg-Johnson2, Dorcas E Beaton2, Bert M Chesworth2, Rajiv Gandhi2, Nizar N Mahomed2, Anthony V Perruccio2, Vaishnav Rajgopal2, Rosalind Wong2, James P Waddell2. 1. Division of Health Care and Outcomes Research (Davis, Perruccio, Wong), Krembil Research Institute and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Institute for Work and Health (Ibrahim, Beaton); Canadian Memorial Chiropractic College (Hogg-Johnson); Dalla Lana School of Public Health (Hogg-Johnson), University of Toronto; Institute of Health Policy, Management and Evaluation (Beaton), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Physical Therapy (Chesworth), Western University, London, Ont.; Arthritis Program (Gandhi, Mahomed), Toronto Western Hospital and Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont.; Orthopaedic Surgery (Rajgopal), Strathroy Middlesex General Hospital, Strathroy, Ont.; Division of Orthopaedic Surgery (Waddell), St. Michael's Hospital and University of Toronto, Toronto, Ont. adavis@uhnresearch.ca. 2. Division of Health Care and Outcomes Research (Davis, Perruccio, Wong), Krembil Research Institute and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Institute for Work and Health (Ibrahim, Beaton); Canadian Memorial Chiropractic College (Hogg-Johnson); Dalla Lana School of Public Health (Hogg-Johnson), University of Toronto; Institute of Health Policy, Management and Evaluation (Beaton), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Physical Therapy (Chesworth), Western University, London, Ont.; Arthritis Program (Gandhi, Mahomed), Toronto Western Hospital and Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont.; Orthopaedic Surgery (Rajgopal), Strathroy Middlesex General Hospital, Strathroy, Ont.; Division of Orthopaedic Surgery (Waddell), St. Michael's Hospital and University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period. METHODS: Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2). Patients undergoing unicompartmental or revision arthroplasty were excluded. Demographic and health (body mass index [BMI], comorbidity) variables and osteoarthritis severity, as assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the disability component of the Late-Life Function and Disability Instrument (LLFDI-D), were collected before surgery. We calculated proportions, means and standard deviations with 95% confidence intervals (CIs) for all data. We constructed density plots by tertile score for the WOMAC pain and physical function subscales and the LLFDI-D limitation scale. RESULTS: There were 494 patients in cohort 1 and 251 patients in cohort 2. There were no differences in age, sex, education, living status, BMI, comorbidity, pain severity or disability between the cohorts based on overlapping 95% CIs and the density plots. More patients in cohort 1 than in cohort 2 were single (176 [35.6%], 95% CI 32.5%-41.1% v. 63 [25.1%], 95% CI 20.3%-31.0%). Patients in cohort 2 reported less limitation in higher-demand activities than did those in cohort 1 (mean score on LLFDI-D 62.3 [95% CI 60.7-63.9] v. 59.2 [95% CI 58.2-60.2]). INTERPRETATION: The patient profile and reported osteoarthritis severity were similar in 2 cohorts that had total knee replacement over a 10-year period. This suggests that increasing total knee replacement volumes over this period likely were not driven by these factors. Copyright 2018, Joule Inc. or its licensors.
BACKGROUND: It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period. METHODS:Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2). Patients undergoing unicompartmental or revision arthroplasty were excluded. Demographic and health (body mass index [BMI], comorbidity) variables and osteoarthritis severity, as assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the disability component of the Late-Life Function and Disability Instrument (LLFDI-D), were collected before surgery. We calculated proportions, means and standard deviations with 95% confidence intervals (CIs) for all data. We constructed density plots by tertile score for the WOMAC pain and physical function subscales and the LLFDI-D limitation scale. RESULTS: There were 494 patients in cohort 1 and 251 patients in cohort 2. There were no differences in age, sex, education, living status, BMI, comorbidity, pain severity or disability between the cohorts based on overlapping 95% CIs and the density plots. More patients in cohort 1 than in cohort 2 were single (176 [35.6%], 95% CI 32.5%-41.1% v. 63 [25.1%], 95% CI 20.3%-31.0%). Patients in cohort 2 reported less limitation in higher-demand activities than did those in cohort 1 (mean score on LLFDI-D 62.3 [95% CI 60.7-63.9] v. 59.2 [95% CI 58.2-60.2]). INTERPRETATION: The patient profile and reported osteoarthritis severity were similar in 2 cohorts that had total knee replacement over a 10-year period. This suggests that increasing total knee replacement volumes over this period likely were not driven by these factors. Copyright 2018, Joule Inc. or its licensors.
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