Quality of life after total knee arthroplasty: systematic review

Silva, Robson Rocha da; Santos, Ayrton André Melo; Carvalho Júnior, José de Sampaio; Matos, Marcos Almeida

doi:10.1016/j.rboe.2014.09.007

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Original Article • Rev. bras. ortop. 49 (5) • Sep-Oct 2014 • https://doi.org/10.1016/j.rboe.2014.09.007 copy

Quality of life after total knee arthroplasty: systematic review^☆ ☆ Please cite this article as: da Silva RR, Santos AAM, de Sampaio Carvalho Júnior J, Matos MA. Qualidade de vida após artroplastia total do joelho: revisão sistemática. Rev Bras Ortop. 2014;49(5):520–7. ,^☆☆ ☆☆ Work developed in the Bahia School of Medicine and Public Health and at Santa Casa de Misericórdia da Bahia, Hospital Santa Izabel, Salvador, BA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors.

Methods:

This was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design.

Results:

31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients.

Conclusion:

The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

Quality of life; Knee arthroplasty; Results assessment (healthcare)

Study number	Author	Year	Level of evidence	Design
1	Narayanasamy et al.	2011	2B	Prospective cohort
2	Santic et al.	2012	2B	Prospective cohort
3	Papakostidou et al.	2012	2B	Prospective cohort
4	Scott et al.	2012	2B	Prospective cohort
5	Grosse Frie et al.	2012	2B	Prospective cohort
6	Baker et al.	2012	2B	Prospective cohort
7	Schwartz et al.	2012	2B	Prospective cohort
8	Zhang et al.	2012	2B	Prospective cohort
10	Desmeules et al.	2010	2B	Prospective cohort
11	Bugala-Szpak et al.	2010	2B	Prospective cohort
12	Kauppila et al.	2010	2B	Prospective cohort
13	Gawel et al.	2010	2B	Prospective cohort
14	Brandes et al.	2010	2B	Prospective cohort
15	Desmeules et al.	2012	2B	Prospective cohort
17	Baumann et al.	2011	2B	Prospective cohort
16	Ackerman et al.	2011	2B	Prospective cohort
17	Gonzalez et al.	2010	2B	Prospective cohort
18	Kilic et al.	2009	2B	Prospective cohort
19	Nunez et al.	2009	2B	Prospective cohort
20	Loughead et al.	2008	2B	Prospective cohort
21	McHugh et al.	2008	2B	Prospective cohort
22	Fitzgerald et al.	2004	2B	Prospective cohort
23	Greidanus	2011	2B	Prospective cohort
24	Rissanen et al.	1996	2B	Prospective cohort
25	Nunez et al.	2007	2B	Prospective cohort
26	Bruyere et al.	2012	2B	Prospective cohort
27	Lingard et al.	2004	2B	Prospective cohort
28	Scott et al.	2010	2B	Prospective cohort
29	Jones et al.	2012	2A	Systematic review
30	Vissers et al.	2012	2A	Systematic review
31	Ethgen et al.	2004	2A	Systematic review

Study number	Follow-up	Scales	Main finding
1	Pre, 6 m, 24 m	SF-36, Oxford	There were improvements in the SF-36 and Oxford scores, especially regarding physical aspects and pain.
2	Pre, 2 y	SF-36	TKA and THA significantly increased elderly patients’ QOL.
3	Pre, 6 w, 3 m, 6 m, 12 m	WOMAC, KSS, VAS	Six weeks after surgery, despite improvement in pain and relief of depressive states, function remained unsatisfactory.
4	Pre, 1 y	Oxford, SF-12	Achievement of expectations was highly correlated with degree of satisfaction.
5		Oxford, EQ-5D	Increases in health indicators after TKA could be achieved through reduction of postoperative complications.
6	Pre, 6 m	Oxford, EQ-5D	The increases in Oxford and EQ-5D scores were significantly greater in TKR than in UKR
7	Pre, 1 y	Oxford, SF-36	There was a significant improvement in dynamic balance one year after surgery.
8	Pre, 6 m, 18 m	SF-36, EuroQol	There were significant improvements in QOL among patients undergoing TKA, both 6 and 18 months after surgery
10	Pre	WOMAC, SF-36	Preoperative waiting time had a significantly negative impact on pain, function and QOL.
11	1–3 d, 6 w	KOOS, SF-36	Sex, age, axis, presence of other implants and preoperative contractures did not significantly QOL after surgery.
12	Pre, 12 m	WOMAC, 15D, Omeract, OARSI	The findings highlighted the multifactorial nature of the state of health in TKA cases.
13	Pre, 4 s	Lysholm and Gilquist, SF-36	The positive effects from surgery could be seen as early as 4 weeks after the operation.
14	Pre, 2 m, 6 m, 12 m	KSS, SF-36, DynaPort ADL monitor, step activity monitor	The level of activity after treatment seems to be more influenced by physical activity behavior before the operation than by the treatment itself.
15	Pre, 6 m	WOMAC, SF-36 OAKHQOL, Quality of Care Scale	Long preoperative waits had a negative impact on QOL and contralateral pain. Patients who were satisfied with the medical information received had high postoperative QOL scores.
16	Pre	AQoL, WOMAC, Kessler PDS	More than half of the participants waiting for joint replacement experienced deterioration of QOL during the waiting period.
17	Pre, 3 m, 12 m	WOMAC, SF-12, EQ-5D	The patients’ expectations were achieved and there were large QOL gains.
18	Pre, 6 s, 3 m, 6 m	SF-36, KSCRS	A significant improvement in QOL was achieved among female patients, six weeks after the operation.
19	Pre, 7 y	WOMAC, SF-36	Obesity and post-discharge complications were associated with worse scores in all dimensions of WOMAC.
20	15 y	WOMAC, SF-36	No significant differences were found between revised and non-revised cases.
21	3 m, 6 m, 9 m	VAS, WOMAC, SF-36	There were significant deteriorations in pain and physical function on the WOMAC scale among patients who were on the waiting list.
22		SF-36	Body pain and physical function improved after arthroplasty. Social support was correlated with improvement of pain and physical function.
23	Pre, 2 y	WOMAC, Oxford-12, SF-12, reported satisfaction	In follow-ups on TKA revision, the patients continued to have worse results, in comparison with primary TKA.
24	Pre, 6 m, 12 m, 24 m.	Nottingham Health, 15D	Greater gains were observed regarding pain, sleep and mobility. On average, in most QOL dimensions, the patients achieved QOL similar to that of the general population.
25	Pre, 36 m	WOMAC	There were significant differences from before to after the operation regarding pain, stiffness and functional scores.
26	Pre, 6 m, 7 y	WOMAC, SF-36	Six months after surgery, an improvement was observed through both SF-36 and WOMAC.
27		WOMAC, SF-36	Patients who had significant functional limitations, severe pain and low mental health scores were more likely to have worse postoperative results.
28	Pre, 6 m, 1 y		Management of patients’ expectations and mental health might reduce dissatisfaction.

ID	Study number	Design	Number of studies analyzed	Details of the study
1	29	Narrative review	33	Clinically significant alterations were found with regard to pain and function from before to after the operation, on the WOMAC scale. Smaller changes were reported regarding joint stiffness. The complication rate from TKA was low. Generic health scales presented lower magnitude of changes, since the construction of these scales includes the effect of other health conditions.
2	30	Systematic review	35	There was strong evidence that patients with catastrophic pain reported more pain after the operation. There was strong evidence that preoperative depression did not influence postoperative function, one year after the operation. There was strong evidence that low preoperative mental health was associated with poor function and pain scores.
3	31	Qualitative systematic review	74	Age was not shown to be an obstacle for the surgery to be effective. Men seemed to be benefited by the surgery more than women. When there were significant comorbidities, the gain was modest. Patients with poorer preoperative QOL presented greater likelihood of gains. Data on health-related QOL are valuable and may provide important information regarding the state of health. Such data should be used rationally for implementing healthcare standards.

QOL protocols	Frequency of use in studies (%)
SF-36/12	18 (35.2%)
WOMAC	12 (22.2%)
Oxford	6 (11.1%)
EQ-5D/EuroQol	4 (7.4%)
KSS	2 (3.7%)
KOOS	1 (1.8%)
15D	2 (3.7%)
Omeract	1 (1.8%)
OARSI	1 (1.8%)
Lysholm	1 (1.8%)
OAKHQOL	1 (1.8%)
Quality of Care Scale	1 (1.8%)
AQoL	1 (1.8%)
Kessler PDS	1 (1.8%)
KSCRS	1 (1.8%)
Nottingham Health	1 (1.8%)

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E-mail: rbo@sbot.org.br

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[1] *Corresponding author. E-mail: malmeidamatos@hotmail.com (M.A. Matos).