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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Presurgery osteoarthritis severity over 10 years in 2 Ontario prospective total knee replacement cohorts: a cohort
Aileen M Davis1, Selahadin Ibrahim2, Sheilah Hogg-Johnson2
1Division of Health Care and Outcomes Research (Davis, Perruccio, Wong), Krembil Research Institute and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Institute for Work and Health (Ibrahim, Beaton); Canadian Memorial Chiropractic College (Hogg-Johnson); Dalla Lana School of Public Health (Hogg-Johnson), University of Toronto; Institute of Health Policy, Management and Evaluation (Beaton), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Physical Therapy (Chesworth), Western University, London, Ont.; Arthritis Program (Gandhi, Mahomed), Toronto Western Hospital and Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont.; Orthopaedic Surgery (Rajgopal), Strathroy Middlesex General Hospital, Strathroy, Ont.; Division of Orthopaedic Surgery (Waddell), St. Michael's Hospital and University of Toronto, Toronto, Ont. adavis@uhnresearch.ca.
Background:
It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period.
Methods:
Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2). Patients undergoing unicompartmental or revision arthroplasty were excluded. Demographic and health (body mass index [BMI], comorbidity) variables and osteoarthritis severity, as assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the disability component of the Late-Life Function and Disability Instrument (LLFDI-D), were collected before surgery. We calculated proportions, means and standard deviations with 95% confidence intervals (CIs) for all data. We constructed density plots by tertile score for the WOMAC pain and physical function subscales and the LLFDI-D limitation scale.
Results:
There were 494 patients in cohort 1 and 251 patients in cohort 2. There were no differences in age, sex, education, living status, BMI, comorbidity, pain severity or disability between the cohorts based on overlapping 95% CIs and the density plots. More patients in cohort 1 than in cohort 2 were single (176 [35.6%], 95% CI 32.5%-41.1% v. 63 [25.1%], 95% CI 20.3%-31.0%). Patients in cohort 2 reported less limitation in higher-demand activities than did those in cohort 1 (mean score on LLFDI-D 62.3 [95% CI 60.7-63.9] v. 59.2 [95% CI 58.2-60.2]).
Interpretation:
The patient profile and reported osteoarthritis severity were similar in 2 cohorts that had total knee replacement over a 10-year period. This suggests that increasing total knee replacement volumes over this period likely were not driven by these factors.
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