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Long-term deterioration of joint evaluation scores
M A Ritter1, A E Thong, K E Davis
1Center for Hip and Knee Surgery, St Francis Hospital, Mooresville, Indiana 46158, USA.
Summary
Long-term joint replacement scores decline due to patient aging, not implant failure. Harris Hip Score and Knee Society Score functional components decreased significantly over time, indicating age-related functional decline impacts patient outcomes.
Area of Science:
- Orthopedics
- Geriatric Medicine
- Biomedical Engineering
Background:
- Total joint arthroplasty (TJA) aims to restore function and alleviate pain.
- Long-term functional outcomes are typically assessed using scoring systems like the Harris Hip Score (HHS) and Knee Society Score (KSS).
- The influence of patient aging on these long-term functional scores, independent of implant integrity, requires further investigation.
Purpose of the Study:
- To evaluate long-term changes in HHS and KSS functional scores after total hip and knee arthroplasty.
- To determine if observed score declines are attributable to overall functional deterioration in aging patients or to prosthesis-related issues.
Main Methods:
- Retrospective analysis of 106 total hip arthroplasties (minimum 10-year follow-up) and 264 total knee arthroplasties (minimum 12-year follow-up).
- Patients included had no medical complications or radiological loosening of the prosthesis.
- Longitudinal assessment of functional components within the HHS and KSS.
Main Results:
- Statistically significant declines were observed in the functional components of both HHS and KSS, despite the absence of implant loosening or complications.
- The HHS functional score decreased by an average of 0.67 points/year (3-10 years post-op), with notable declines in gait, support aid use, walking distance, and stair climbing.
- The KSS functional score decreased by an average of 0.88 points/year (3-12 years post-op), affecting all functional components including walking distance, stair climbing, and support aid use.
Conclusions:
- Long-term functional score deterioration in total joint arthroplasty patients, even without implant failure, is significantly influenced by age-related functional decline.
- The HHS score may be inaccurately interpreted as declining solely due to implant issues when functional and pain components are combined.
- Age-related functional capacity changes are a critical factor to consider in longitudinal evaluations of TJA outcomes using standardized scoring systems.