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Barker K1,2, Hannink E1,2, Pemberton S1, Jenkins C1
1Nuffield Orthopaedic Centre, Physiotherapy Research Unit, Oxford, United Kingdom, 2University of Oxford, Nuffield Department for Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
Background: While more than 80% of individuals undergoing a knee arthroplasty (KA) have good outcomes and satisfaction with their surgery, patient and health care professionals' expectations of KA recovery are variable and there is no evidence-based timeline to provide guidance when returning to important functional and leisure activities.
Purpose: To determine evidence-based guidance for the length of time to return to specific valued functional and leisure activities following KA; to determine what participants feel are the most important functional and leisure activities to return to after KA; and to collect information about participants' expectations and compare them to the actual time it takes to return to the activities.
Methods: Prospective longitudinal cohort observational survey of people with osteoarthritis or rheumatoid arthritis listed for Total Knee Arthroplasty (TKA) or Unicompartmental Knee Arthroplasty (UKA). Participants' expectations on returning to specific activities were recorded prior to surgery, and then followed up with multiple phone calls (3 weeks, 6 weeks, 3 months, 6 months and 12 months) over the year after surgery to record their actual return to activities. The main outcome measure was a record of the length of time to return to their specified valued functional and leisure activities.
Results: Of 99 participants who were consented and underwent a KA, 41 had a TKA and 58 had a UKA. The mean participant age (SD) was 69.6 (9.1) years, 59 were female, 55 had the operation on their right side, and 5 participants had rheumatoid arthritis. For 57% of the participants, the most important activity to return to was walking. The activity with the largest discrepancy between initial expectation and 12-month satisfaction was kneeling; 78% wanted to return to kneeling and only 36% were comfortable or satisfied with it at 12 months. Activities that participants returned to more quickly than expected were housework (Z=-5.631, p 0.05, effect size=0.64) and swimming (Z=-3.209, p 0.05, effect size=0.59). The activity that participants returned to slower than expected was walking over 1 km (Z=-2.324, p 0.05, effect size=0.27). Returning to work, kneeling, gardening, driving, and stairs showed no significant difference between expectation and actual return. In the majority of activities, the UKA group returned on average more quickly than the TKA group, but on average they were all satisfied with the activity at the same time.
Conclusion(s): While the gap in between expected time and actual time to return to specific activities was difficult to define due to the large variance in the data, we were able to identify trends in the recovery timeline in the UKA group compared to the TKA group. By 12 months post-surgery, most participants had returned to the activities they valued and, with the exception of kneeling, most were satisfied and comfortable doing these activities.
Implications: A more tailored and personalised approach with consideration of prior level of activity and comorbidities must be taken into account and adequately discussed in order to help guide patient recovery after KA.
Keywords: Knee arthoplasty, Patient expectation, Arthritis
Funding acknowledgements: Oxford University Hospitals Charitable Fund Reference 9822
Purpose: To determine evidence-based guidance for the length of time to return to specific valued functional and leisure activities following KA; to determine what participants feel are the most important functional and leisure activities to return to after KA; and to collect information about participants' expectations and compare them to the actual time it takes to return to the activities.
Methods: Prospective longitudinal cohort observational survey of people with osteoarthritis or rheumatoid arthritis listed for Total Knee Arthroplasty (TKA) or Unicompartmental Knee Arthroplasty (UKA). Participants' expectations on returning to specific activities were recorded prior to surgery, and then followed up with multiple phone calls (3 weeks, 6 weeks, 3 months, 6 months and 12 months) over the year after surgery to record their actual return to activities. The main outcome measure was a record of the length of time to return to their specified valued functional and leisure activities.
Results: Of 99 participants who were consented and underwent a KA, 41 had a TKA and 58 had a UKA. The mean participant age (SD) was 69.6 (9.1) years, 59 were female, 55 had the operation on their right side, and 5 participants had rheumatoid arthritis. For 57% of the participants, the most important activity to return to was walking. The activity with the largest discrepancy between initial expectation and 12-month satisfaction was kneeling; 78% wanted to return to kneeling and only 36% were comfortable or satisfied with it at 12 months. Activities that participants returned to more quickly than expected were housework (Z=-5.631, p 0.05, effect size=0.64) and swimming (Z=-3.209, p 0.05, effect size=0.59). The activity that participants returned to slower than expected was walking over 1 km (Z=-2.324, p 0.05, effect size=0.27). Returning to work, kneeling, gardening, driving, and stairs showed no significant difference between expectation and actual return. In the majority of activities, the UKA group returned on average more quickly than the TKA group, but on average they were all satisfied with the activity at the same time.
Conclusion(s): While the gap in between expected time and actual time to return to specific activities was difficult to define due to the large variance in the data, we were able to identify trends in the recovery timeline in the UKA group compared to the TKA group. By 12 months post-surgery, most participants had returned to the activities they valued and, with the exception of kneeling, most were satisfied and comfortable doing these activities.
Implications: A more tailored and personalised approach with consideration of prior level of activity and comorbidities must be taken into account and adequately discussed in order to help guide patient recovery after KA.
Keywords: Knee arthoplasty, Patient expectation, Arthritis
Funding acknowledgements: Oxford University Hospitals Charitable Fund Reference 9822
Topic: Musculoskeletal: lower limb; Orthopaedics
Ethics approval required: Yes
Institution: NHS Health Research Authority
Ethics committee: NRES Committee London - Queen Square
Ethics number: 15/LO/1307
All authors, affiliations and abstracts have been published as submitted.
