Advertisement

Aging Clinical and Experimental Research

, Volume 30, Issue 4, pp 315–321 | Cite as

Profile of osteoarthritic patients undergoing hip or knee arthroplasty, a step toward a definition of the “need for surgery”

  • Audrey Neuprez
  • Arnaud H. Neuprez
  • William Kurth
  • Philippe Gillet
  • Olivier Bruyère
  • Jean-Yves Reginster
Original Article

Abstract

Aims

The objective of this study is to characterize, based on clinical, radiographic, health-related, quality-of-life-related, and demographic variables, the profile of a large, homogeneous, cohort of patients undergoing knee or hip arthroplasty, in a public hospital. Current regulatory guidelines for structure-modifying agent are not clear regarding hard clinical endpoint. The “need for surgery” has been suggested as a potential relevant outcome, but, until now, it is poorly defined. By characterizing a large number of patients who undergo total hip or total knee replacement, this paper aims at providing a contribution to the better definition of the “need for surgery” in advanced OA of the lower limbs.

Methods

Consecutive patients who underwent primary knee arthroplasty (KA) or hip arthroplasty (HA) between December 2008 and February 2013, in an academic hospital, and who were diagnosed with hip or knee osteoarthritis (OA) (ACR criteria). Data collected at baseline included demographic and clinical data; Kellgren–Lawrence radiological grading; Western Ontario and Mc Master Universities Arthritis Index (WOMAC); EuroQol five dimensions questionnaire and EuroQol visual analog scale; and 36-item Short Form Health Survey.

Results

626 subjects were included, 346 with hip OA and 280 with knee OA. Significant differences between subjects in need of an HA or of a KA were seen in terms of age (66.5 years versus 65 for hip), duration of complaints (2188 days versus 1146.5 for hip), BMI (28.68 kg/m² versus 27.07), radiological status (severe OA were found in 79.85% in knee group and 68.73% in hip group), comorbidities (FCI higher in knee group), traumatic of surgical history (37 versus 6%), and health-related quality of life and function (patients with HA had a poorer clinical status regarding WOMAC and WOMAC subscale).

Conclusion

Significant differences were observed between patients undergoing KA or HA. These differences might be useful to better understand the “need for surgery” status in these indications. This concept may help to define responders and failures to pharmacological treatment of OA.

Keywords

Osteoarthritis Hip Knee Arthroplasty Treatment 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The local ethics committee approved this trial.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40520_2017_780_MOESM1_ESM.xlsx (108 kb)
Supplementary material 1 (XLSX 108 KB)

References

  1. 1.
    Glyn-Jones S et al (2015) Osteoarthritis. Lancet 386:376–387CrossRefPubMedGoogle Scholar
  2. 2.
    Pereira D et al (2011) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil 19:1270–1285CrossRefPubMedGoogle Scholar
  3. 3.
    Litwic A et al (2013) Epidemiology and burden of osteoarthritis. Br Med Bull 105:185–199CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Deshpande BR et al (2016) The number of persons with symptomatic knee osteoarthritis in the United States: impact of race/ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken) 68:1743–1750Google Scholar
  5. 5.
    Cross M et al (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73:1323–1330CrossRefPubMedGoogle Scholar
  6. 6.
    Hiligsmann M et al (2013) Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 43:303–313CrossRefPubMedGoogle Scholar
  7. 7.
    Hunter DJ (2011) Osteoarthritis. Best Pract Res Clin Rheumatol 25:801–814CrossRefPubMedGoogle Scholar
  8. 8.
    Reginster JY et al (2015) Recommendations for an update of the 2010 European regulatory guideline on clinical investigation of medicinal products used in the treatment of osteoarthritis and reflections about related clinically relevant outcomes: expert consensus statement. Osteoarthritis Cartilage 23:2086–2093CrossRefPubMedGoogle Scholar
  9. 9.
    Bruyere O et al (2014) An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 44:253–263CrossRefPubMedGoogle Scholar
  10. 10.
    Bruyere O et al (2016) A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Semin Arthritis Rheum 45:S3–S11CrossRefPubMedGoogle Scholar
  11. 11.
    Carr AJ et al (2012) Knee replacement. Lancet 379:1331–1340CrossRefPubMedGoogle Scholar
  12. 12.
    Pivec R et al (2012) Hip arthroplasty. Lancet 380:1768–1777CrossRefPubMedGoogle Scholar
  13. 13.
    OECD (2015) Hip and knee replacement, in Health at a Glance 2015: OECD Indicators. OECD publishing, Paris, pp 112–113Google Scholar
  14. 14.
    Cutolo M et al (2015) Commentary on recent therapeutic guidelines for osteoarthritis. Semin Arthritis Rheum 44:611–617CrossRefPubMedGoogle Scholar
  15. 15.
    Altman RD et al (2005) Total joint replacement of hip or knee as an outcome measure for structure modifying trials in osteoarthritis. Osteoarthr Cartil 13:13–19CrossRefPubMedGoogle Scholar
  16. 16.
    Abadie E et al (2004) Recommendations for the use of new methods to assess the efficacy of disease-modifying drugs in the treatment of osteoarthritis. Osteoarthr Cartil 12:263–268CrossRefPubMedGoogle Scholar
  17. 17.
    Groll DL et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602CrossRefPubMedGoogle Scholar
  18. 18.
    Bellamy N et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  19. 19.
    Ware JE, Kosinski M, Keller SK (1994) SF-36 physical and mental health summary scale: a user’s manual. The health institute ed, BostonGoogle Scholar
  20. 20.
    Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343CrossRefPubMedGoogle Scholar
  21. 21.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bijlsma JW, Berenbaum F, Lafeber FP (2011) Osteoarthritis: an update with relevance for clinical practice. Lancet 377:2115–2126CrossRefPubMedGoogle Scholar
  23. 23.
    Silverwood V et al (2015) Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthr Cartil 23:507–515CrossRefPubMedGoogle Scholar
  24. 24.
    Srikanth VK et al (2005) A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil 13:769–781CrossRefPubMedGoogle Scholar
  25. 25.
    Kulkarni K et al (2016) Obesity and osteoarthritis. Maturitas 89:22–28CrossRefPubMedGoogle Scholar
  26. 26.
    Gelber AC et al (1999) Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med 107:542–548CrossRefPubMedGoogle Scholar
  27. 27.
    Sokolove J, Lepus CM (2013) Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 5:77–94CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Azamar-Llamas D et al (2017) Adipokine contribution to the pathogenesis of osteoarthritis. Mediat Inflamm 2017:5468023CrossRefGoogle Scholar
  29. 29.
    Veronese N et al (2016) Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: data from the osteoarthritis initiative. Clin Nutr. doi: 10.1016/j.clnu.2016.09.035
  30. 30.
    Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 11:203–209CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Peter WF et al (2015) The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty. Rheumatol Int 35:1233–1241CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Jones CA, Pohar S (2012) Health-related quality of life after total joint arthroplasty: a scoping review. Clin Geriatr Med 28:395–429CrossRefPubMedGoogle Scholar
  33. 33.
    Jenkins PJ et al (2013) Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Jt J 95-B:115–121CrossRefGoogle Scholar
  34. 34.
    Mont MA et al (2014) Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis. J Knee Surg 27:369–376PubMedGoogle Scholar
  35. 35.
    Sadoghi P et al (2013) Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty 28:1329–1332CrossRefPubMedGoogle Scholar
  36. 36.
    Ethgen O et al (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Jt Surg Am 86-A:963–974CrossRefGoogle Scholar
  37. 37.
    Jain NB et al (2005) Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res 435:232–238CrossRefGoogle Scholar
  38. 38.
    Richmond SA et al (2013) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 43:515–519CrossRefPubMedGoogle Scholar
  39. 39.
    Dowsey MM et al (2012) The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis. Knee 19:860–865CrossRefPubMedGoogle Scholar
  40. 40.
    Keurentjes JC et al (2013) Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study. PLoS One 8:e59500CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Tilbury C et al (2016) Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients. Acta Orthop 87:67–71CrossRefPubMedGoogle Scholar
  42. 42.
    Valdes AM et al (2012) Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum 41:568–575CrossRefPubMedGoogle Scholar
  43. 43.
    Bruyere O et al (2002) Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol 31:13–16CrossRefPubMedGoogle Scholar
  44. 44.
    McHugh GA et al (2008) Patients waiting for a hip or knee joint replacement: is there any prioritization for surgery? J Eval Clin Pract 14:361–367CrossRefPubMedGoogle Scholar
  45. 45.
    Shao Y et al (2013) The fate of the remaining knee(s) or hip(s) in osteoarthritic patients undergoing a primary TKA or THA. J Arthroplasty 28:1842–1845CrossRefPubMedGoogle Scholar
  46. 46.
    Sanders TL et al (2017) Subsequent total joint arthroplasty after primary total knee or hip arthroplasty: a 40-year population-based study. J Bone Jt Surg Am 99:396–401CrossRefGoogle Scholar
  47. 47.
    Chang A et al (2010) Frequency of varus and valgus thrust and factors associated with thrust presence in persons with or at higher risk of developing knee osteoarthritis. Arthritis Rheum 62:1403–1411CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Audrey Neuprez
    • 1
    • 2
    • 3
  • Arnaud H. Neuprez
    • 1
  • William Kurth
    • 2
  • Philippe Gillet
    • 2
  • Olivier Bruyère
    • 1
  • Jean-Yves Reginster
    • 1
  1. 1.Department of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
  2. 2.Orthopaedic Surgery DepartmentUniversity Hospital of LiègeLiègeBelgium
  3. 3.Rehabilitation and Sports Traumatology DepartmentUniversity Hospital of LiègeLiègeBelgium

Personalised recommendations