Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study

Erik Lenguerrand, Vikki Wylde, Rachael Gooberman-Hill, Adrian Sayers, Luke Brunton, Andrew D Beswick, Paul Dieppe, Ashley W Blom, Erik Lenguerrand, Vikki Wylde, Rachael Gooberman-Hill, Adrian Sayers, Luke Brunton, Andrew D Beswick, Paul Dieppe, Ashley W Blom

Abstract

Background and purpose: Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms.

Methods: The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0-3 months and 3-12 months).

Results: Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not 'caught-up' with those with less severe pre-operative symptoms 12 months after their surgery.

Conclusion: Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3-12 months. Further investigations are now required to determine if patients with severe symptoms at the time of their knee arthroplasty have a different pre-surgical history than those with less severe symptoms and if they could benefit from earlier surgical intervention and tailored rehabilitation to achieve better post-operative patient-reported outcomes.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Hip-Mean trajectories a for WOMAC-pain…
Fig 1. Hip-Mean trajectoriesa for WOMAC-pain and WOMAC-function (Unstandardised outcomes) by high vs. low pre-operative pain/functionb.
A. The mean trajectories are derived from the fixed effects of linear mixed model stratified on high-low profile and regressing each outcome on the time of assessment parameterised as two linear splines. B. High/low function status defined on pre-operative WOMAC-function or -pain using their median scores (54 and 55) as cut-points.
Fig 2. Knee -Mean trajectories a for…
Fig 2. Knee -Mean trajectoriesa for WOMAC-pain and WOMAC-function (Unstandardized outcomes) by high vs. low pre-operative pain/functionb.
A. The mean trajectories are derived from the fixed effects of linear mixed model stratified on high-low profile and regressing each outcome on the time of assessment parameterised as two linear splines. B. High/low function status defined on pre-operative WOMAC-function or -pain using their median scores (51 and 45) as cut-points.

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