Scripties UMCG - Rijksuniversiteit Groningen
 
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Extent of recovery after revision arthroplasty of the hip and knee.

(2017) Luttkus, K. (Karen)

Background: An increase in life expectancy and obesity worldwide lead to a higher incidence of osteoarthritis (OA). The standard surgical treatment of end-stage OA is total joint arthroplasty. With an increase in frequency of placing artificial joints, revision arthroplasty becomes more prevalent as well. However, little is known about the extent of recovery after revision total knee arthroplasty (TKA) and revision total hip arthroplasty (THA). Objective: To gain insight into the extent of recovery after revision TKA or THA and whether physiotherapy and surgery indication (septic or aseptic) is of influence. Additionally, the amount of physiotherapy in Germany and the Netherlands is analyzed for whether there are significant differences. Methods: A retrospective cross sectional, multi-centered and multi-national study was performed by sending out questionnaires to patients who underwent revision TKA or THA six to 12 months prior. The questionnaires contained questions about the amount of physiotherapy, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) which were converted into the Western Ontario and McMaster Universities Arthritis index (WOMAC) to evaluate perceived physical functioning. Additionally postoperative activity levels were measured by the International Physical Activity Questionnaire (IPAQ) and the European Quality of Life scale five dimensions questionnaire (EQ-5D-3L) measured health and quality of life at one moment in time. Statistical analysis was performed by means of descriptive statistics, ANOVA, Mann-Whitney-U tests, T-test, and regression analysis to gain insight into the extent of recovery in relation to the amount of physiotherapy, the indication for operation, and the country of operation. Results: The regression analysis showed that the amount of physiotherapy, the country of operation, the interaction effect between country and total hours of physiotherapy, the operated joint (hip or knee), and the amount of comorbidities are of predictive value on perceived physical functioning. In regards to satisfaction, aseptic revision TKA patients scored significantly higher than septic revision TKA patients (p=0.047). German patients completed a significantly higher amount of physiotherapy exercises postoperatively with a therapist (p<0.001) and total amount of exercises at home and with a therapist compared to Dutch patients (p=0.01). Conclusion: All patient groups that received high amounts of physiotherapy scored higher in perceived physical functioning. Especially septic revision TKA patients benefit greatly from increased amounts of physiotherapy. A tailored program for septic revision arthroplasty patients could benefit the functional outcome.






 
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