Modeling early recovery of physical function following hip and knee arthroplasty

Deborah M Kennedy, Paul W Stratford, Steven E Hanna, Jean Wessel, Jeffrey D Gollish, Deborah M Kennedy, Paul W Stratford, Steven E Hanna, Jean Wessel, Jeffrey D Gollish

Abstract

Background: Information on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures.

Methods: A sample of convenience of 152 subjects completed testing, of which 69 (mean age: 66.77 +/- 8.23 years) underwent THA and 83 (mean age: 60.25 +/- 11.19 years) TKA. Postoperatively, patients were treated using standardized care pathways and rehabilitation protocols. Using a repeated measures design, patients were assessed at multiple time points over the first four postoperative months. Outcome measures included the Lower Extremity Function Scale (LEFS), the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC PF), the 6 minute walk test (6 MWT), timed up and go test (TUG) and a timed stair test (ST). Average recovery curves for each of the measures were characterized using hierarchical linear modeling. Predictors of recovery were sequentially modeled after validation of the basic developmental models.

Results: Slopes of recovery were greater in the first 6 to 9 weeks with a second-degree polynomial growth term (weeks squared) providing a reasonable fit for the data over the study interval. Different patterns of recovery were observed between the self-report measures of physical function and the performance measures. In contrast to the models for the WOMAC PF and the LEFS, site of arthroplasty was a significant predictor (p = 0.001) in all of the physical performance measure models with the patients post TKA initially demonstrating higher function. Site of arthroplasty (p = 0.025) also predicted the rate of change for patients post THA and between 9 to 11 weeks after surgery, the THA group surpassed the function of the patients post TKA.

Conclusion: Knowledge about the predicted growth curves will assist clinicians in referencing patient progress, and determining the critical time points for measuring change. The study has contributed further evidence to highlight the benefit of using physical performance measures to learn about the patients' actual level of disability.

Figures

Figure 1
Figure 1
Predicted Recovery Curves for the Six Minute Walk Test According to Site of Arthroplasty.
Figure 2
Figure 2
Predicted Recovery Curves for the Timed Up and Go According to Site of Arthroplasty.
Figure 3
Figure 3
Predicted Recovery Curves for the Stair Test According to Site of Arthroplasty.
Figure 4
Figure 4
Predicted Recovery Curves for the WOMAC Physical Function Subscale According to Site of Arthroplasty.
Figure 5
Figure 5
Predicted Recovery Curves for the Lower Extremity Function Scale According to Site of Arthroplasty.

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