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. 2024 Mar 11;5(3):202-209.
doi: 10.1302/2633-1462.53.BJO-2023-0035.R1.

First knee for pain and function versus second knee for quality of life

Adriane M Lewin  1   2 , Kara Cashman  3 , Dylan Harries  3 , Ilana N Ackerman  4 , Justine M Naylor  1   2   5 , Ian A Harris  1   2   5   6
Affiliations

First knee for pain and function versus second knee for quality of life

Adriane M Lewin et al. Bone Jt Open. .

Abstract

Aims: The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis.

Methods: This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively.

Results: The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains 'mobility', 'usual activities', and 'pain/discomfort' were better following the second TKA.

Conclusion: At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Study cohort. *Patient-reported outcome measures (PROMs) were implemented as a pilot project with staged implementation at a limited number of sites. Once implemented, 97.8% of patients completed preoperative and 79% completed postoperative data. OKS, Oxford Knee Score.
Fig. 2
Fig. 2
Mean Oxford Knee Score at baseline and six months post-surgery by operative side.
Fig. 3
Fig. 3
Mean EuroQol five-dimension (EQ-5D) visual analogue scale (VAS) scores at baseline and six months post-surgery, by operative siide.
Fig. 4
Fig. 4
Mean EuroQol five-dimension (EQ-5D) index score at baseline and six months’ post-surgery by operative side.
Fig. 5
Fig. 5
EuroQol five-dimension (EQ-5D) domains at baseline and six months post-surgery by operative side – percentage of patients who report ‘no problems’.
See this image and copyright information in PMC

References

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