Temporal patterns of commonly used clinical outcome scales during a 5-year period after total knee arthroplasty

Vivek Tiwari, Jonggeun Lee, Gaurav Sharma, Yeon Gwi Kang, Tae Kyun Kim, Vivek Tiwari, Jonggeun Lee, Gaurav Sharma, Yeon Gwi Kang, Tae Kyun Kim

Abstract

Background: It is not established beyond doubt whether improvements in functional outcome after total knee arthroplasty (TKA) are maintained in the long term. We therefore investigated the temporal patterns of functional outcome [using range of motion (ROM), American Knee Society (AKS) score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and 36-Item Short Form Health Survey (SF-36) score] over a 5-year period after uncomplicated TKA, and whether these patterns differed by implant type and patient age.

Materials and methods: This prospective study evaluated 138 patients who underwent unilateral TKA with either a mobile-bearing (MB) or fixed-bearing (FB) posterior-stabilized prosthesis. An independent investigator evaluated the functional outcome at five time points: preoperatively and at 6-month, 1-year, 2-year, and 5-year follow-up. Differences in functional outcomes between adjacent time points were evaluated by mixed-effect model repeat measurement (MMRM).

Results: The different functional outcome scores showed improvement till 6 months-2 years, followed by a variable decline. In patients aged ≥ 68 years with an MB implant, most of the functional outcome scores declined between 2 and 5 years after variable initial improvement till 6 months-2 years, whereas the parameters plateaued after 2 years in those aged < 68 years and in older patients with an FB implant.

Conclusions: A decline in function and pain relief occurs 2 years after TKA. This decline is more evident in older patients with an MB prosthesis. Based on these findings, we believe that use of MB implants in older patients (≥ 68 years) requires further investigation.

Level of evidence: Level 3.

Keywords: Age; Functional outcome; Pattern; Prosthesis; Total knee arthroplasty.

Conflict of interest statement

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart showing details of patient enrollment and follow-up
Fig. 2
Fig. 2
Line diagrams depicting the various outcome parameters over 5 years (error bars depict standard deviation): a ROM, b AKS knee score, c AKS function score; d WOMAC pain score, e WOMAC stiffness score, f WOMAC function score, g SF-36 PCS score, and h SF-36 MCS score

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