Observational Study
Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2023; 14(12): 853-867
Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.853
Table 1 Patient demographics
Total knee replacement (n = 63) Total hip replacement (n = 68) Age (yr), mean ± SD 72.1 ± 8.3 68.7 ± 9.4 Gender (male:female) 22:41 27:41 Laterality (left:right:bilateral) 27:34:2 27:41:0 Height (m), mean ± SD 1.62 ± 0.09 1.66 ± 0.10 Weight (kg), mean ± SD 80.2 ± 15.1 82.6 ± 16.7 BMI (kg/m2 ), mean ± SD 30.4 ± 4.2 30.0 ± 5.5 ASA median (range) 2 (1-3) 2 (1-3) SCQ median (range) 4 (0-15) 5 (0-18)
Table 2 Comparison of pre-operative and post-operative patient reported outcome measure scores: Total knee replacement
Pre-operative (n = 63), median (IQR) Post-operative (n = 63), median (IQR) P value1 Z valueKOOS pain 36 (25-44) 92 (77 – 98) < 0.001a -6.617 KOOS symptoms 36 (21-46) 89 (82 – 93) < 0.001a -6.842 KOOS ADL 38 (31-44) 88 (78-97) < 0.001a -6.902 KOOS Sport/Rec 5 (0-25) 70 (50-86) < 0.001a -4.571 KOOS QoL 13 (6-25) 75 (56-93) < 0.001a -6.457 Overall KOOS 28.9 (18.2-37.9) 80.7 (64.5-89.4) < 0.001a -5.160 WOMAC pain 40 (30-50) 90 (80-100) < 0.001a -6.575 WOMAC stiffness 25 (25-37.5) 75 (63-100) < 0.001a -6.708 WOMAC function 38.2 (30.9-44.1) 91.2 (77.9-97.1) < 0.001a -6.625 Oxford knee score 15 (11-19) 40 (33-43) < 0.001a -6.618 EQ-5D index 0.345 (0.211-0.548) 0.821 (0.703-1) < 0.001a -6.237 EQ-5D VAS 65 (50-80) 83 (71-95) < 0.001a -5.323 SF-12 PCS 27.6 (23.2-32.1) 43.8 (33.0-50.4) < 0.001a -5.333 SF-12 MCS 47.0 (39.3-56.5) 58.6 (51.5-61.3) < 0.001a -3.832
Table 3 Comparison of pre-operative and post-operative patient reported outcome measure scores: Total hip replacement
Pre-operative (n = 68), median (IQR) Post-operative (n = 68), median (IQR) P value1 Z valueHOOS pain 33 (25-40) 92 (77-98) < 0.001a -4.868 HOOS symptoms 38 (30-49) 89 (82-93) < 0.001a -4.909 HOOS ADL 37 (26-43) 88 (78-97) < 0.001a -4.841 HOOS Sport/Rec 19 (6-31) 70 (50-86) < 0.001a -4.788 HOOS QoL 19 (6-31) 75 (56-93) < 0.001a -4.663 Overall HOOS 28.9 (18.2-37.9) 80.7 (64.5-89.4) < 0.001a -4.681 WOMAC pain 40 (30-49) 95 (85-100) < 0.001a -4.932 WOMAC stiffness 25 (25-50) 88 (75-100) < 0.001a -4.760 WOMAC function 36.8 (28.3-44.1) 91.9 (75.7-98.5) < 0.001a -4.864 Oxford hip score 14 (10-20) 42 (35-47) < 0.001a -4.912 EQ-5D index 0.335 (0.169-0.533) 0.857 (0.643-1) < 0.001a -4.918 EQ-5D VAS 65 (50-80) 90 (79-95) < 0.001a -4.357 SF-12 PCS 24.8 (21.7-29.3) 50.6 (36.5-55.0) < 0.001a -4.623 SF-12 MCS 49.6 (39.9-58.3) 57.8 (55.4-59.8) 0.076 -1.776
Table 4 Comparison of pre-operative and post-operative patient reported outcome measure scores: Total knee replacement vs total hip replacement
TKR (n = 63), median (IQR) THR (n = 68), median (IQR) P value1 Z valueU valueKOOS/HOOS pain Pre-operative 36 (25-44) 33 (25-40) 0.597 -0.528 1755 Post-operative 92 (77-98) 95 (84-100) 0.208 -0.370 1206 KOOS/HOOS symptoms Pre-operative 36 (21-46) 38 (30-49) 0.415 -0.415 1729 Post-operative 89 (82-93) 90 (80-100) 0.629 -0.483 1189 KOOS/HOOS ADL Pre-operative 38 (31-44) 37 (26-43) 0.298 -1.040 1656 Post-operative 88 (78-97) 91 (76-98) 0.711 -0.370 1206 KOOS/HOOS Sport/Rec Pre-operative 5 (0-25) 19 (6-31) 0.030a -2.164 1001 Post-operative 70 (50-86) 75 (56-100) 0.158 -0.141 738 KOOS/HOOS QoL Pre-operative 13 (6-25) 19 (6-31) 0.106 -1.616 1519 Post-operative 75 (56-93) 84 (58-94) 0.499 -0.676 1030 KOOS/HOOS overall Pre-operative 28.9 (18.2-37.9) 28.0 (21.0-37.6) 0.833 -0.211 1267 Post-operative 80.7 (64.5-89.4) 88.8 (72.9-95.5) 0.140 -1.476 713 WOMAC pain Pre-operative 40 (30-50) 40 (30-49) 0.984 -0.02 1886 Post-operative 90 (80-100) 95 (85-100) 0.297 -1.04 1020 WOMAC stiffness Pre-operative 25 (25-37.5) 25 (25-50) 0.583 -0.55 1786 Post-operative 75 (63-100) 88 (75-100) 0.309 -1.02 1114 WOMAC function Pre-operative 38.2 (30.9-44.1) 36.8 (28.3-44.1) 0.639 -0.47 1798 Post-operative 91.2 (77.9-97.1) 91.9 (75.7-98.5) 0.945 -0.07 1151 OKS/OHS Pre-operative 15 (11-19) 14 (10-20) 0.859 -0.177 1826 Post-operative 40 (33-43) 42 (35-47) 0.076 -1.775 932 EQ-5D index Pre-operative 0.345 (0.211-0.548) 0.335 (0.169-0.533) 0.719 -0.36 1761 Post-operative 0.821 (0.703-1) 0.857 (0.643-1) 0.386 -0.87 988 EQ-5D VAS Pre-operative 65 (50-80) 65 (50-80) 0.308 -1.02 1579 Post-operative 83 (71-95) 90 (79-95) 0.374 -0.89 1019 SF-12 PCS Pre-operative 27.6 (23.2-32.1) 24.8 (21.7-29.3) 0.073 -1.79 1308 Post-operative 43.8 (33.0-50.4) 50.6 (36.5-55.0) 0.106 -1.62 690 SF-12 MCS Pre-operative 47.0 (39.3-56.5) 49.6 (39.9-58.3) 0.777 -0.28 1574 Post-operative 58.6 (51.5-61.3) 57.8 (55.4-59.8) 0.438 -0.78 784
Table 5 Comparison of pre-operative and post-operative total knee replacement patient reported outcome measure scores: Cruciate retaining vs posterior stabilised implants
Cruciate retaining (n = 36), median (IQR) Posterior stabilised (n = 27), median (IQR) P value1 Z valueU valueKOOS pain Pre-operative 36 (23-44) 36 (25-42) 0.568 -0.57 445.0 Post-operative 89 (69-100) 94 (83-97) 0.271 -1.10 348.5 KOOS symptoms Pre-operative 36 (26-53) 32 (21-43) 0.181 -1.34 390.0 Post-operative 86 (80-89) 89 (86-93) 0.074 -1.79 358.5 KOOS ADL Pre-operative 39 (31-46) 38 (29-44) 0.950 -0.06 481.5 Post-operative 88 (75-96) 94 (82-97) 0.292 -1.05 410.5 KOOS Sport/Rec Pre-operative 5 (0-29) 5 (0-25) 0.721 -0.36 277.0 Post-operative 70 (50-85) 70 (60-95) 0.671 -0.43 237.5 KOOS QoL Pre-operative 6 (2-25) 13 (6-27) 0.408 -0.83 411.0 Post-operative 75 (56-81) 75 (61-94) 0.557 -0.59 354.5 Overall KOOS Pre-operative 29. 8 (20.8-36.5) 27.2 (16.8-38.5) 0.880 -0.15 286.5 Post-operative 81.3 (64.0-88.8) 80.7 (75.3-90.8) 0.730 -0.35 232.0 WOMAC pain Pre-operative 40 (30-50) 35 (30-50) 0.867 -0.17 474.0 Post-operative 90 (75-100) 95 (85-100) 0.376 -0.88 363.0 WOMAC stiffness Pre-operative 25 (25-47) 25 (25-38) 0.930 -0.09 480.0 Post-operative 75 (63-88) 75 (75-100) 0.112 -1.59 374.5 WOMAC function Pre-operative 39.0 (30.9-45.2) 38.2 (29.4-44.1) 0.851 -0.19 472.5 Post-operative 88.2 (73.5-97.1) 94.1 (82.4-97.0) 0.286 -1.07 350.5 Oxford knee score Pre-operative 14 (11-21) 15 (12-18) 0.760 -0.31 451.0 Post-operative 41 (33-43) 40 (34-44) 0.794 -0.26 408.0 EQ-5D index Pre-operative 0.322 (0.217-0.530) 0.392 (0.181-0.568) 0.747 -0.32 428.0 Post-operative 0.795 (0.679-1) 0.829 (0.714-1) 0.885 -0.15 368.5 EQ-5D VAS Pre-operative 65 (50-80) 80 (53-83) 0.180 -1.34 348.5 Post-operative 85 (79-95) 80 (70-86) 0.151 -1.44 346.5 SF-12 PCS Pre-operative 28.1 (23.2-31.6) 25.7 (23.4-32.5) 0.653 -0.45 379.5 Post-operative 43.8 (34.9-52.2) 44.6 (28.3-50.9) 0.572 -0.57 248.5 SF-12 MCS Pre-operative 44.0 (38.7-53.9) 49.7 (41.6-57.1) 0.294 -1.05 341.5 Post-operative 57.5 (49.9-60.6) 59.4 (51.4-61.6) 0.306 -1.02 227.0
Table 6 Comparison of pre-operative and post-operative total hip replacement patient reported outcome measure scores: Cemented, uncemented and hybrid fixations
Cemented (n = 36), median (IQR) Uncemented (n = 28), median (IQR) Hybrid (n = 4), median (IQR) P value1 H valueHOOS pain Pre-operative 35 (22.4-44.6) 31 (25-38) 40 (33-X) 0.512 1.338 Post-operative 95 (70-100) 98 (93-100) 89 (83- X) 0.332 2.205 HOOS symptoms Pre-operative 40 (30-50) 35 (29-45) 35 (15-X) 0.544 1.216 Post-operative 85 (75-90) 95 (85-100) 73 (65-X) 0.046a 6.614 HOOS ADL Pre-operative 37 (25-43) 35 (28-44) 40 (35-X) 0.808 0.425 Post-operative 91 (68-96) 98 (84-100) 80 (66-X) 0.176 3.479 HOOS Sport/Rec Pre-operative 16 (5-27) 25 (6-43) 25 (19-X) 0.611 0.986 Post-operative 75 (48-95) 94 (75-100) 59 (50-X) 0.111 4.405 HOOS QoL Pre-operative 19 (6-31) 19 (13-38) 31 (25-X) 0.401 1.827 Post-operative 75 (50-94) 88 (69-100) 56 (50-X) 0.259 2.703 Overall HOOS Pre-operative 26.1 (19.7-40.0) 29.7 (21.5-40.3) 35.9 (25.3-X) 0.812 0.418 Post-operative 88.4 (64.8-92.2) 95.0 (79.0-98.8) 71.4 (65.2-X) 0.130 4.086 WOMAC pain Pre-operative 45 (25-55) 35 (30-40) 40 (35-X) 0.497 1.398 Post-operative 95 (65-100) 95 (90-100) 90 (80-X) 0.764 0.538 WOMAC stiffness Pre-operative 25 (25-50) 25 (25-38) 25 (25-X) 0.964 0.074 Post-operative 88 (75-88) 88 (75-100) 69 (63-X) 0.170 3.540 WOMAC function Pre-operative 39.7 (26.5-50.0) 34.6 (29.0-44.1) 39.7 (35.3-X) 0.790 0.472 Post-operative 91.2 (67.7-95.6) 98.5 (83.8-100) 80.1 (66.2-X) 0.190 3.317 Oxford hip score Pre-operative 14 (10-19) 14 (11-22) 19 (17-X) 0.238 2.872 Post-operative 41 (33-46) 44 (39-47) 38 (34-X) 0.347 2.118 EQ-5D index Pre-operative 0.375 (0.155-0.533) 0.314 (0.217-0.535) 0.604 (0.482-X) 0.128 4.106 Post-operative 0.836 (0.592-1) 1 (0.747-1) 0.790 (0.580-X) 0.529 1.274 EQ-5D VAS Pre-operative 65 (50-80) 65 (39-80) 60 (60-X) 0.938 0.127 Post-operative 90 (70-95) 90 (80-98) 80 (65-X) 0.779 0.499 SF-12 PCS Pre-operative 25.0 (21.1-27.3) 25.3 (21.9-31.1) 24.7 (20.4-X) 0.597 1.030 Post-operative 50.6 (32.3-54.8) 53.4 (43.3-55.8) 42.9 (36.4-X) 0.447 1.610 SF-12 MCS Pre-operative 49.5 (41.1-58.2) 50.6 (38.7-58.6) 50.7 (34.4-X) 0.980 0.040 Post-operative 56.6 (53.7-59.8) 59.2 (57.3-60.8) 47.1 (36.1-X) 0.128 4.104
Table 7 Pre-operative and post-operative impact of body mass index category on patient reported outcome measure scores: Total knee replacements
Normal (n = 8), median (IQR) Overweight (n = 24), median (IQR) Obese (n = 31), median (IQR) P value1 H valueKOOS pain Pre-operative 41 (22-51) 38 (26-49) 33 (22-42) 0.230 2.936 Post-operative 97 (95-100) 92 (73-97) 88 (72-98) 0.046a 6.160 KOOS symptoms Pre-operative 32 (23-62) 38 (21-56) 32 (22-43) 0.701 0.712 Post-operative 91 (86-95) 89 (86-93) 86 (79-93) 0.129 4.098 KOOS ADL Pre-operative 40 (25-53) 38 (34-45) 40 (26-43) 0.466 1.527 Post-operative 96 (89-99) 91 (78-97) 87 (76-96) 0.214 3.079 KOOS Sport/Rec Pre-operative 5 (0-63) 8 (0-25) 5 (0-20) 0.621 0.952 Post-operative 75 (60-100) 73 (51-84) 65 (45-88) 0.582 1.083 KOOS QoL Pre-operative 19 (0-44) 19 (6-31) 6 (6-19) 0.302 2.394 Post-operative 91 (75-99) 75 (63-100) 63 (47-81) 0.032a 6.881 Overall KOOS Pre-operative 36.5 (12.1-51.1) 32.2 (20.8-43.8) 26.6 (16.7-33.7) 0.354 2.075 Post-operative 87 (80-97) 81.3 (67.2-92.0) 79.9 (64.1-84.8) 0.208 3.139 WOMAC pain Pre-operative 45 (25-54) 40 (30-50) 35 (25-50) 0.332 2.206 Post-operative 100 (95-100) 90 (75-99) 90 (79-100) 0.045a 6.186 WOMAC stiffness Pre-operative 38 (6-59) 25 (25-47) 25 (25-38) 0.704 0.702 Post-operative 100 (75-100) 75 (63-100) 75 (63-88) 0.084 4.960 WOMAC function Pre-operative 39.7 (25.0-53.3) 38.2 (34.1-45.2) 39.7 (26.5-44.1) 0.521 1.302 Post-operative 97.1 (93.0-100) 91.2 (78.3-97.1) 86.0 (75.7-97.1) 0.125 4.154 Oxford knee score Pre-operative 17 (11-23) 15 (11-19) 14 (11-19) 0.566 1.137 Post-operative 39 (38-40) 42 (33-45) 39 (33-43) 0.559 1.165 EQ-5D index Pre-operative 0.502 (0.107-0.630) 0.304 (0.215-0.479) 0.356 (0.206-0.535) 0.606 1.002 Post-operative 0.837 (0.821-1) 0.837 (0.735-1) 0.767 (0.633-0.939) 0.260 2.696 EQ-5D VAS Pre-operative 80 (65-80) 80 (50-90) 60 (50-70) 0.139 3.940 Post-operative 80 (74-85) 85 (70-95) 85 (70-90) 0.652 0.856 SF-12 PCS Pre-operative 29.6 (24.8-36.4) 28.2 (23.9-37.8) 27.2 (21.6-29.9) 0.257 2.714 Post-operative 49.0 (44.0-51.7) 46.9 (30.1-53.3) 38.5 (32.5-49.6) 0.379 1.942 SF-12 MCS Pre-operative 48.2 (38.1-54.6) 50.1 (40.0-59.6) 45.0 (38.6-54.1) 0.692 0.737 Post-operative 58.6 (53.4-60.6) 59.3 (44.2-62.3) 57.8 (51.2-60.5) 0.897 0.208
Table 8 Pre-operative and post-operative impact of body mass index category on patient reported outcome measure scores: Total hip replacements
Normal (n = 14), median (IQR) Overweight (n = 16), median (IQR) Obese (n = 34), median (IQR) Morbidly obese (n = 4), median (IQR) P value1 H valueHOOS pain Pre-operative 38 (23-43) 35 (29-44) 30 (25-39) 22.5 (15-X) 0.405 2.917 Post-operative 99 (65-100) 99 (86-100) 93 (73-97) 97 (97-97) 0.310 3.582 HOOS symptoms Pre-operative 40 (28-53) 38 (25-53) 40 (30-49) 35 (25-X) 0.720 1.339 Post-operative 90 (63-100) 98 (69-100) 85 (78-90) 85 (85-85) 0.718 1.349 HOOS ADL Pre-operative 39 (23-48) 38 (32-42) 33 (27-43) 18 (18-X) 0.277 3.860 Post-operative 92 (67-99) 98 (73-100) 84 (63-96) 94 (94-94) 0.294 3.712 HOOS Sport/Rec Pre-operative 28 (20-31) 25 (19-44) 6 (0-25) 13 (6-X) 0.088 6.536 Post-operative 88 (75-100) 91 (55-100) 63 (34-91) 75 (75-75) 0.252 4.090 HOOS QoL Pre-operative 25 (6-41) 25 (19-31) 19 (13-25) 13 (0-X) 0.486 2.443 Post-operative 88 (58-100) 81 (53-98) 69 (38-90) 94 (94-94) 0.376 3.106 Overall HOOS Pre-operative 35.9 (29.9-41.7) 36.0 (24.8-38.5) 25.7 (20.7-33.3) 25.0 (12.8-X) 0.267 3.950 Post-operative 91.2 (88.8-100) 95.1 (68.3-98.6) 79.0 (60.4-90.0) 89.0 (89.0-89.0) 0.256 4.047 WOMAC pain Pre-operative 40 (33-63) 38 (31-53) 38 (30-45) 25 (15-X) 0.445 2.673 Post-operative 100 (68.8-100) 100 (85-100) 90 (75-98) 95 (95-95) 0.332 3.417 WOMAC stiffness Pre-operative 38 (19-50) 38 (25-50) 25 (25-38) 25 (13-X) 0.377 3.099 Post-operative 94 (56-100) 94 (66-100) 75 (75-88) 75 (75-75) 0.483 2.459 WOMAC function Pre-operative 39.7 (30.1-54.4) 39.7 (32.0-43.8) 33.1 (26.8-44.1) 17.6 (17.6-X) 0.267 3.951 Post-operative 91.9 (69.1-99.3) 98.5 (73.2-99.6) 83.8 (63.2-95.6) 94.1 (94.1-94.1) 0.313 3.562 Oxford hip score Pre-operative 23 (12-29) 18 (13-22) 13 (10-19) 7 (5-X) 0.046a 8.001 Post-operative 44 (35-47.75) 44 (36-48) 39 (31-45) 47 (47-47) 0.275 3.882 EQ-5D index Pre-operative 0.527 (0.059-0.699) 0.481 (0.235-0.568) 0.289 (0.210-0.420) 0.169 (-0.199-X) 0.305 3.624 Post-operative 1 (0.659-1) 1 (0.685-1) 0.750 (0.639-0.892) 1 (1-1) 0.158 5.198 EQ-5D VAS Pre-operative 60 (40-80) 80 (60-85) 65 (40-74) 65 (40-X) 0.250 4.105 Post-operative 93 (60-100) 94 (71-100) 80 (75-84) 90 (90-90) 0.106 6.114 SF-12 PCS Pre-operative 31.8 (19.7-37.1) 26.8 (22.5-37.9) 24.1 (21.4-27.6) 25.0 (21.7-X) 0.370 3.144 Post-operative 54.8 (40.5-56.0) 49.3 (36.4-55.3) 43.9 (28.0-54.8) 49.3 (49.3-49.3) 0.590 1.914 SF-12 MCS Pre-operative 59.5 (51.2-63.1) 53.5 (39.9-61.7) 47.4 (40.1-52.7) 32.3 (16.7-X) 0.075 6.919 Post-operative 57.5 (55.9-59.8 59.8 (55.7-60.8) 57.7 (50.2-59.8) 60.8 (60.8-60.8) 0.334 3.396