Total Joint Arthroplasties: Current Concepts of Patient Outcomes after Surgery

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Total hip and knee arthroplasties are effective surgical interventions for relieving hip pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all report gains or are satisfied after receiving total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis, and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no single patient-related or perioperative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

Section snippets

Pain and function

Favorable gains reported for joint pain and functional status following total hip and knee arthroplasties are well established within the orthopedic literature. Treatment effectiveness entails within-patient change over time or longitudinal measurement. The recovery pattern is one of improvement occurring within the first few weeks after surgery, with the largest gains seen within the first 3 to 6 months [19], [20], [21], [22], [23], [24]. Patients with total hip arthroplasties report

Determinants of pain function and health-related quality of life outcomes

The clinical decision to undergo surgery for a total joint arthroplasty involves potential risks weighed against the benefits for each patient. Pain, function, prosthetic/technical issues, as well as medical and surgical factors need to be considered. Although revision and mortality rates are known for this patient population, there remains uncertainty regarding how a given health state affects the outcomes of this surgical procedure. Thus, the patient–physician decision-making process may not

Summary

Focus of outcome research for total joint arthroplasties has been directed toward understanding the surgical and technical aspects. More recent evaluations of total joint arthroplasties have used patient-centered outcomes. The lack of success reported by some patients can be attributed to surgical-related factors or complications, but in others, no specific reason can be identified. Little is known about the causal inferences of clinical variables on these outcomes; however, several patient

Acknowledgments

The authors express gratitude for the constructive comments by Dr. David H. Feeny.

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    A version of this article originally appeared in the 21:3 issue of Clinics in Geriatric Medicine.

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