Impact of Arthroplasty Sequence on Functional Outcomes Following Ipsilateral Total Hip and Knee Arthroplasty
Abstract
Introduction: Osteoarthritic patients who undergo index total hip or knee replacement have higher likelihood of receiving subsequent arthroplasties. This study hypothesises that patients who receive THR first have better functional outcomes than patients who receive TKR before ipsilateral THR.
Materials and methods: This retrospective study analysed 60 patients with ipsilateral THR and TKR from January 1999 to December 2014. Group 1 underwent THR before TKR (n=27, interval between surgeries 50.4±37.8 months) while Group 2 underwent TKR first (n=33, interval between surgeries 42.1±34.4 months). Functional outcome scores – Short Form Health Survey (SF-36), Oxford Knee Score (OKS), Knee Society Score (KSSFS), Oxford Hip Score (OHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) – were recorded pre-operatively, six-months and two-years post-operatively.
Results: Pre-operatively, Group 1 patients had superior SF-36 physical component scores (33.8±10.4 vs 28.3±8.0, P=0.028) compared to Group 2. Group 1 patients had superior 6-month OKS (20.7±5.2 vs 26.8±10.9, P=0.035) and 2-year KSSFS (66.8±13.3 vs 56.2±24.1, P=0.020) post-TKR. Both groups demonstrated improvements in SF-36 scores after the 2nd surgery. Group 1 patients had superior satisfaction rates (1.9±0.6 vs 2.8±1.5, P=0.019) and expectations met (1.9±0.8 vs 2.8±1.8, P=0.04).
Conclusion: In patients with ipsilateral THR and TKR, those with THR first had superior early functional outcomes. This may be due to technical disease factors such as altered kinematics of the arthritic hip, or knee pain resulting from referred hip pain as a cognate joint. Further studies to evaluate long term outcomes of patients with ipsilateral TKR and THR is recommended.
Abstract | Reference
