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Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction.
Knee Surg Sports Traumatol Arthrosc. 2019 Apr; 27(4):1196-1203.KS

Abstract

PURPOSE

Symptoms of stiffness after total knee arthroplasty (TKA) cause significant morbidity, but there is limited data to facilitate identification of those most at risk after surgery. Stratifying risk can aid earlier directed treatment options.

METHODS

A retrospective cohort consisting of 2589 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed for 1 year. Patients with a worse WOMAC stiffness score in 1 year were defined as the "increased" stiffness group and the other cohort as the non-stiffness group.

RESULTS

At 1 year after surgery 129 (5%) patients had a significant increase in their stiffness symptoms (20%, 95% confidence interval (CI) 17.9-22.0, p < 0.001), and had significantly (all p < 0.001) less of an improvement in their pain, function and total WOMAC scores, and SF-12 scores compared to the non-stiffness group (n = 2460). Patient satisfaction was significantly lower (odds ratio (OR) 0.178, CI 0.121 to 0.262, p < 0.001) for the increased stiffness group. Logistic regression analysis identified male gender (OR 1.66, p = 0.02), lung disease (OR 2.06, p = 0.002), diabetes (OR 1.82, p = 0.02), back pain (OR 1.81, p = 0.005), and a pre-operative stiffness score of 44 or more (OR 5.79, p < 0.001) were significantly predictive of increased stiffness.

CONCLUSION

Patients with increased symptoms of stiffness after TKA have a worse functional outcome and a lower rate of patient satisfaction, and patients at risk of being in this group should be informed pre-operatively.

LEVEL OF EVIDENCE

Retrospective prognostic study, Level III.

Authors+Show Affiliations

Department of Orthopaedics, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DD, UK.Department of Orthopaedics, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DD, UK.Department of Orthopaedics, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DD, UK.Department of Orthopaedics, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DD, UK.Department of Orthopaedics, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DD, UK. deehan1@hotmail.co.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29748697

Citation

Clement, N D., et al. "Increased Symptoms of Stiffness 1 Year After Total Knee Arthroplasty Are Associated With a Worse Functional Outcome and Lower Rate of Patient Satisfaction." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 27, no. 4, 2019, pp. 1196-1203.
Clement ND, Bardgett M, Weir D, et al. Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1196-1203.
Clement, N. D., Bardgett, M., Weir, D., Holland, J., & Deehan, D. J. (2019). Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 27(4), 1196-1203. https://doi.org/10.1007/s00167-018-4979-2
Clement ND, et al. Increased Symptoms of Stiffness 1 Year After Total Knee Arthroplasty Are Associated With a Worse Functional Outcome and Lower Rate of Patient Satisfaction. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1196-1203. PubMed PMID: 29748697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. AU - Clement,N D, AU - Bardgett,M, AU - Weir,D, AU - Holland,J, AU - Deehan,D J, Y1 - 2018/05/10/ PY - 2018/02/04/received PY - 2018/05/04/accepted PY - 2018/5/12/pubmed PY - 2019/5/22/medline PY - 2018/5/12/entrez KW - Knee replacement KW - Outcome KW - Predictors KW - Stiffness KW - TKA KW - Total knee arthroplasty SP - 1196 EP - 1203 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 27 IS - 4 N2 - PURPOSE: Symptoms of stiffness after total knee arthroplasty (TKA) cause significant morbidity, but there is limited data to facilitate identification of those most at risk after surgery. Stratifying risk can aid earlier directed treatment options. METHODS: A retrospective cohort consisting of 2589 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed for 1 year. Patients with a worse WOMAC stiffness score in 1 year were defined as the "increased" stiffness group and the other cohort as the non-stiffness group. RESULTS: At 1 year after surgery 129 (5%) patients had a significant increase in their stiffness symptoms (20%, 95% confidence interval (CI) 17.9-22.0, p < 0.001), and had significantly (all p < 0.001) less of an improvement in their pain, function and total WOMAC scores, and SF-12 scores compared to the non-stiffness group (n = 2460). Patient satisfaction was significantly lower (odds ratio (OR) 0.178, CI 0.121 to 0.262, p < 0.001) for the increased stiffness group. Logistic regression analysis identified male gender (OR 1.66, p = 0.02), lung disease (OR 2.06, p = 0.002), diabetes (OR 1.82, p = 0.02), back pain (OR 1.81, p = 0.005), and a pre-operative stiffness score of 44 or more (OR 5.79, p < 0.001) were significantly predictive of increased stiffness. CONCLUSION: Patients with increased symptoms of stiffness after TKA have a worse functional outcome and a lower rate of patient satisfaction, and patients at risk of being in this group should be informed pre-operatively. LEVEL OF EVIDENCE: Retrospective prognostic study, Level III. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/29748697/Increased_symptoms_of_stiffness_1_year_after_total_knee_arthroplasty_are_associated_with_a_worse_functional_outcome_and_lower_rate_of_patient_satisfaction_ L2 - https://dx.doi.org/10.1007/s00167-018-4979-2 DB - PRIME DP - Unbound Medicine ER -