Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group Health-related quality of life and appropriateness of knee or hip joint replacement. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients Joint Recovery Programme Versus Usual Care: An Economic Evaluation of a Clinical Pathway for Joint Replacement Surgery Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis? Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Patterns of recovery following knee and hip replacement in an Australian cohort. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study
OBJECTIVE To compare the health-related quality of life of people with osteoarthritis before and after primary total hip and knee replacement surgery  with that of the general Australian population . DESIGN A prospect i ve cohort study . SETTING Three Sydney hospitals , public and private . PARTICIPANTS Patients with osteoarthritis undergoing primary total hip ( n = 59 ) and knee ( n = 92 ) joint replacement surgery .  MAIN OUTCOME MEASURE Medical Outcomes Study Short Form ( SF-36 ) scores before and 12 months after joint replacement surgery ( compared with population norms ) . RESULTS Patients in each age group showed a significant improvement in health-related quality of life after joint replacement surgery in most scales of the SF-36 , particularly physical function , role physical and bodily pain . SF-36 scores for the 42 hip-replacement patients aged 55 - 74 years improved to equal or exceed the population norm on all scales . SF-36 scores of the 52 knee replacement patients aged 55 - 74 years improved , but physical function and bodily pain scores remained significantly worse than the population norm . SF-36 scores for both hip ( n = 17 ) and knee ( n = 40 ) replacement patients aged 75 years and over improved significantly , becoming similar to population norms for this age group . CONCLUSIONS Total hip or knee replacement for osteoarthritis significantly improves patient health and well-being at 12 months after surgery . Age alone should not be a barrier to surgery OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population Objective To assess health-related quality of life ( HRQOL ) in a prospect i ve study with 7 years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis . Methods Generic HRQOL was assessed with the  short-form 36 ( SF-36 ) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results Out of the 39 subjects who have completed the 7 years of follow-up of this study , 22 ( 56.4 % ) underwent a hip replacement surgery and the other 17 ( 43.6 % ) a knee replacement . Six months after surgery , a significant improvement , compared to preoperative scores , was observed in two of the eight dimensions of the SF-36 ( i.e. physical function and pain ) . The same dimensions , pain and physical function , at the same time , 6 months after surgery , measured by the WOMAC , showed a significant improvement as well , but there was no significant change in the stiffness score . From 6 months to the end of follow-up , changes in SF-36 scores showed a significant improvement in physical function ( p = 0.008 ) , role-physical ( p = 0.004 ) and role-emotional ( p = 0.01 ) while all scores of the WOMAC improved ( p < 0.001 for pain , p < 0.001 for stiffness and p < 0.01 for physical function ) . Conclusion The improvements observed in HRQOL at short term after surgery , are at least maintained over a 7-year follow-up period Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response Objective . To define pain and physical function cutpoints that would , coupled with structural severity , define a surrogate measure of “ need for joint replacement surgery , ” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis ( OA ) . Methods . New scores were developed for pain and physical function in knee and hip OA . A cross-sectional international study in 1909 patients was conducted to define data -driven cutpoints corresponding to the orthopedic surgeons ’ indication for joint replacement . A post hoc analysis of 8 r and omized clinical trials ( 1379 patients ) evaluated the prevalence and validity of cutpoints , among patients with symptomatic hip/knee OA . Results . In the international cross-sectional study , there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement ; indeed , it was not possible to determine cutpoints for pain and function defining this indication . The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression , high level of pain , and high degree of function impairment was low ( 2%–12 % ) . The most discriminatory cutpoint to define an indication for joint replacement was found to be [ pain ( 0–100 ) + physical function ( 0–100 ) > 80 ] . Conclusion . These results do not support a specific level of pain or function that defines an indication for joint replacement . However , a tentative cutpoint for pain and physical function levels is proposed for further evaluation . Potentially , this symptom level , coupled with radiographic progression , could be used to define “ nonresponders ” to disease-modifying drugs in OA clinical trials BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants Background Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes . However , some people experience long-term pain . Objectives To review published studies in representative population s with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity . Data sources MEDLINE and EMBASE data bases search ed to January 2011 with no language restrictions . Citations of key articles in ISI Web of Science and reference lists were checked . Study eligibility criteria , participants and interventions Prospect i ve studies of consecutive , unselected osteoarthritis patients representative of the primary total hip or knee replacement population , with intensities of patient-centred pain measured after 3 months to 5-year follow-up . Study appraisal and synthesis methods Two authors screened titles and abstract s. Data extracted by one author were checked independently against original articles by a second . For each study , the authors summarised the proportions of people with different severities of pain in the operated joint . Results Search es identified 1308 articles of which 115 reported patient-centred pain outcomes .  Fourteen articles describing 17 cohorts ( 6 with hip and 11 with knee replacement ) presented appropriate data on pain intensity . The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7 % to 23 % after hip and 10 % to 34 % after knee replacement . In the best quality studies , an unfavourable pain outcome was reported in 9 % or more of patients after hip and about 20 % of patients after knee replacement . Limitations Other studies reported mean values of pain outcomes . These and routine clinical studies are potential sources of relevant data . Conclusions and implication s of key findings After hip and knee replacement , a significant proportion of people have painful joints . There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes Objective : The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement , the Joint Recovery Programme ( JRP )  , as compared with usual care . The existing care process was revised to contain costs and shorten waiting lists by facilitating patient flows and improve healthcare efficiency . Methods : The study design was a before – after trial . In total , 160 patients undergoing total hip and total knee replacement , aged 28 to 87 years ( mean age , 64.4 years ) , were treated either according to the Joint Recovery Programme ( a st and ardized care process with patient education and rehabilitation in groups ) or usual care . Both groups were followed for 1 year . Costs were studied from a societal perspective . Outcomes included functional level ( Harris Hip score and American Knee Society score ) and generic quality of life ( EuroQol ) . Results : The results indicate that the Joint Recovery Programme result ed in a significant cost saving when compared with usual care mainly as a result of a considerable ( > 50 % ) reduction in length of hospital stay . The average cost saving per patient amounted to $ 1261 in the total hip replacement group and $ 3336 in the total knee replacement group . At the same time , both functional level and quality of life were higher in the JRP group . Conclusions : Clinical pathway dominates usual care and is a highly cost-effective approach to contain costs related to joint replacement surgery without adverse consequences for patients Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : OBJECTIVE To determine if behavioral grade d activity ( BGA ) results in better long-term effectiveness ( 5 years after inclusion ) than usual exercise therapy ( UC ; usual care ) in patients with osteoarthritis ( OA ) of the hip or knee . METHOD Long-term follow-up study of a single blind cluster r and omized trial comparing BGA and UC .  One hundred and forty-nine patients out of the 200 included were followed until 60 months ' follow-up . Primary outcome measures were pain , physical function , and patient global assessment . Furthermore , patient-oriented physical function , physical performance , health care utilization and the number of joint replacement surgeries were assessed . Assessment s took place at 3 , 9 , 15 and 60 months ' follow-up . Data were analyzed according to intent-to-treat principle . RESULTS Both treatments showed beneficial within-groups effects in the long-term . In patients with knee OA no differences between treatments were found on the short- , mid-long and long-term . In patients with hip OA significant differences in favor of BGA were found at 3 months ' ( pain and physical performance ) and 9 months ' follow-up ( pain , physical function , patients global assessment and patient-oriented physical function ) . Furthermore , UC result ed in patients with hip OA in more joint replacement surgeries compared to BGA ( hazard ratio [ HR ] , 2.87 ; 95 % confidence interval [ CI ] , 1.1 ; 7.3 ) . CONCLUSION No differences between treatment groups were found in the long-term on the primary outcome measures . Although more research is needed to confirm the study findings , the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA , which probably can be explained by better outcome in favor of BGA in the short- and mid-long-term This paper aims to compare the results of single-joint knee vs hip hyaluronic acid ( HA ) injections in patients with osteoarthritis ( OA ) involving both the knee and hip joints . Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled . Patients were divided into two groups to receive HA injection three times at 1-week intervals either to the hip or knee joints . Pain level during activities and rest was measured by using visual analog scale ( VAS ) . Western Ontario and McMaster University Osteoarthritis Index ( WOMAC 5-point Likert 3.0 ) was also used prior to the injections and 1 month after the 3rd injection . In the knee injection group , the intragroup analysis revealed significant improvements in VAS activity pain , VAS rest pain , and WOMAC pain values following injection when compared with preinjection values , while no significant difference was detected in WOMAC stiffness , WOMAC physical function , and WOMAC total values . In the hip injection group , VAS activity pain , VAS rest pain , WOMAC pain , WOMAC stiffness , WOMAC physical function , and WOMAC total values showed significant improvement after the injection when compared with preinjection values . Although statistically not significant ( p > 0.05 ) , the comparison of the differences ( preinjection – postinjection ) between the groups demonstrated higher values in the hip injection group . We imply that intra-articular single-joint HA injections either to the knee or hip joints in OA patients with involvement of both of these joints are effective with regard to pain and functional status OBJECTIVE To determine the predictors of outcome in patients with osteoarthritis 2 years after receiving total hip or knee replacement .  METHODS A prospect i ve cohort study of 222 osteoarthritis patients undergoing total hip or knee replacement in Boston and Montreal was done . Their postoperative outcomes at 6 months were previously reported . This followup reports on the outcomes after 2 years among the 165 patients ( 74 % ) who remained . The subjects were divided into 2 groups according to the median value of their preoperative Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) function score . The Short Form 36-item physical function subscale and the WOMAC pain and function subscale scores were collected at baseline and at 3 , 6 , and 24 months postoperatively . Clinical outcomes were analyzed at 2 years , using descriptive and multiple regression analyses . RESULTS Improvements in pain and function at 2 years were similar to those observed at 6 months . Those subjects with the worst function and pain at the time of surgery ( baseline ) had comparatively worse function 2 years after surgery . CONCLUSION In this comparison , the poor outcomes observed at 6 months following total joint replacement in patients with worse baseline functional status persisted after 2 years . Although there are no vali date d indications for when a patient should optimally have total joint replacement , these data suggest that timing of surgery may be more important than previously realized and , specifically , that performing surgery earlier in the course of functional decline may be associated with better outcome Background Patients with knee and /or hip osteoarthritis ( OA ) are less physically active than the general population , while the benefits of physical activity ( PA ) have been well documented . Based on the behavioral grade d activity treatment , we developed a Web-based intervention to improve PA levels in patients with knee and /or hip OA , entitled “ Join2move ” . The Join2move intervention is a self-paced 9-week PA program in which the patient ’s favorite recreational activity is gradually increased in a time-contingent way . Objective The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and /or hip OA would result in improved levels of PA , physical function , and self-perceived effect compared with a waiting list control group . Methods The study design was a two-armed r and omized controlled trial which was not blinded . Volunteers were recruited via articles in newspapers and health-related websites . Eligibility criteria for participants were : ( 1 ) aged 50 - 75 years , ( 2 ) self-reported knee and /or hip OA , ( 3 ) self-reported inactivity ( 30 minutes of moderate PA , 5 times or less per week ) , ( 4 ) no face-to-face consultation with a health care provider other than general practitioners , for OA in the last 6 months , ( 5 ) ability to access the Internet weekly , and ( 6 ) no contra-indications to exercise without supervision . Baseline , 3-month , and 12-month follow-up data were collected through online question naires . Primary outcomes were PA , physical function , and self-perceived effect . In a subgroup of participants , PA was measured objective ly using accelerometers . Secondary outcomes were pain , fatigue , anxiety , depression , symptoms , quality of life , self-efficacy , pain coping , and locus of control . Results Of the 581 interested respondents , 199 eligible participants were r and omly assigned to the intervention ( n=100 ) or waiting list control group ( n=99 ) . Response rates of question naires were 84.4 % ( 168/199 ) after 3 months and 75.4 % ( 150/199 ) after 12 months . In this study , 94.0 % ( 94/100 ) of participants actually started the program , and 46.0 % ( 46/100 ) reached the adherence threshold of 6 out of 9 modules completed . At 3 months , participants in the intervention group reported a significantly improved physical function status ( difference=6.5 points , 95 % CI 1.8 - 11.2 ) and a positive self-perceived effect ( OR 10.7 , 95 % CI 4.3 - 26.4 ) compared with the control group . No effect was found for self-reported PA . After 12 months , the intervention group showed higher levels of subjective ( difference=21.2 points , 95 % CI 3.6 - 38.9 ) and objective PA ( difference=24 minutes , 95 % CI 0.5 - 46.8 ) compared with the control group . After 12 months , no effect was found for physical function ( difference=5 points , 95 % CI −1.0 to 11.0 ) and self-perceived effect ( OR 1.2 , 95 % CI 0.6 - 2.4 ) . For several secondary endpoints , the intervention group demonstrated improvements in favor of the intervention group . Conclusions Join2move result ed in changes in the desired direction for several primary and secondary outcomes . Given the benefits and its self-help format , Join2move could be a component in the effort to enhance PA in sedentary patients with knee and /or hip OA . Trial Registration The Netherl and s National Trial Register : NTR2483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2483 ( Archived by WebCite at http://www.webcitation.org/67NqS6Beq ) OBJECTIVES To study responsiveness and establish the minimal clinical ly important differences ( MCID ) and minimal detectable change ( MDC ) in patients undergoing total hip replacement ( THR )  using the Short Form 36 ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . METHODS We conducted a prospect i ve observational study in three public hospitals of all consecutive patients with a diagnosis of hip osteoarthritis ( OA ) on waiting lists to undergo THR .  Patients completed the SF-36 and the  WOMAC  ( subscales transformed to 0 to 100 ) , which measured the health-related quality of life ( HRQoL ) , before intervention and 6 months and 2 years later , and additional transitional questions , which measured the changes in the joint 6 months postoperatively . RESULTS Improvements at 6 months after a THR were between 37 ( stiffness ) and 39 points ( pain ) , depending on the WOMAC domain . The SF-36 domains also showed improvements : physical function ( 31.91 ) , physical role ( 33.71 ) , and bodily pain ( 29.77 ) . From 6 months to 2 years , improvements ranged from 2 to 5 points , except for role physical ( 13.25 ) . A ceiling effect was detected on some WOMAC domains as well as a floor effect on the SF-36 . The MCID ranged from 25.91 ( stiffness ) to 29.26 ( pain ) on the WOMAC and from 10.78 ( physical role ) to 20.40 ( physical function ) on the SF-36 . The MDC ranged from 21.38 ( pain ) to 27.98 ( stiffness ) on the WOMAC and from 18.99 ( physical function ) to 42.05 ( social function ) on the SF-36 . CONCLUSIONS These values indicate expected gains after THR . However , the MCID and MDC values must be viewed cautiously due to the uncertainty of these estimators and should not be considered as absolute thresholds OBJECTIVES To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis ( OA ) or following joint replacement . METHODS An international , multidisciplinary expert advisory group was established to guide the study . Potential tests for consideration in the recommended set were identified via a survey of selected experts and through a systematic review of the measurement properties for performance-based tests . A multi-phase , consensus-based approach was used to prioritize and select performance-based tests by applying decision analysis methodology ( 1000Minds software ) via online decision surveys . The recommended tests were chosen based on available measurement-property evidence , feasibility of the tests , scoring methods and expert consensus . RESULTS Consensus incorporated the opinions of 138 experienced clinicians and research ers from 16 countries . The five tests recommended by the advisory group and endorsed by Osteoarthritis Research Society International ( OARSI ) were the  30-s chair-st and test , 40 m fast-paced walk test , a stair-climb test , timed up- and -go test and 6-min walk test . The first three were recommended as the minimal core set of performance-based tests for hip or knee OA . CONCLUSION The OARSI recommended set of performance-based tests of physical function represents the tests of typical activities relevant to individuals diagnosed with hip or knee OA and following joint replacements . These tests are complementary to patient-reported measures and are recommended as prospect i ve outcome measures in future OA research and to assist decision-making in clinical practice . Further research should be directed to exp and ing the measurement-property evidence of the recommended tests BACKGROUND AND OBJECTIVES Efficiency-based healthcare decision-making has been widely accepted for some time , with cost per quality -adjusted life year ( QALY ) as the main outcome measure . Nevertheless , for numerous medical procedures , little data are available on the cost per QALY gained . The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures , as well as with the maximum threshold cost considered acceptable in Spain . METHODS We performed a prospect i ve cohort pre-test/post-test study of patients undergoing primary hip or knee arthroplasty .  Age , sex , and clinical variables were recorded . Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments , respectively , before the intervention and 6 months later . The direct costs of the intervention were calculated , with length of hospital stay and the prosthesis as the main cost drivers . RESULTS A total of 80 patients , 40 from each intervention , were included in this study . Both functional and perceived health status improved after the intervention . The number of QALYs gained in the knee cohort was 4.64 , while that in the hip cohort was 0.86 . The total cost of  knee replacement  was lower ( 6,865.52 euro ) than that of hip replacement ( 7,891.21 euro ) . The cost per QALY gained was 1,275.84 euro and 7,936.12 euro for knee and hip interventions , respectively . The calculations performed included a 6 % discount rate for health outcomes , a 3 % inflation rate for costs , and a success rate of 95 % at 15 years . CONCLUSIONS The costs of both knee and hip replacement were lower than the threshold of 30,000 euro per QALY considered acceptable in Spain , and compared favorably with other medical and surgical procedures Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients Background Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis ( OA ) . The most well-known is the disease-specific Stanford Arthritis Self-Management Program ( ASMP ) . While Australian and international clinical guidelines promote the concept of self-management for OA , there is currently little evidence to support the use of the ASMP . Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability . However , previous studies have had method ological shortcomings including the use of outcome measures which do not accurately reflect program goals . Additionally , limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored . Methods / design This study is a r and omised controlled trial to determine the efficacy ( in terms of Health-Related Quality of Life and self-management skills ) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practice s within 2 private hospital setting s in Victoria , Australia . Participants must be 18 years or over , fluent in English and able to attend ASMP sessions . Exclusion criteria include cognitive dysfunction , previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement . Eligible , consenting participants will be r and omised to an intervention group ( who receive the ASMP and an arthritis self-management book ) or a control group ( who receive the book only ) . Follow-up will be at 6 weeks , 3 months and 12 months using st and ardised self-report measures . The primary outcome is Health-Related Quality of Life at 12 months , measured using the Assessment of Quality of Life instrument . Secondary outcome measures include the Health Education Impact Question naire , Western Ontario and McMaster Universities Osteoarthritis Index ( pain subscale and total scores ) , Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool . Cost-utility analyses will be undertaken using administrative records and self-report data . A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP . Discussion Using an innovative design combining both quantitative and qualitative components , this project will provide high quality data to facilitate evidence -based recommendations regarding the ASMP OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST Most literature reporting the impressive results from knee and hip replacement derives from international data . Few Australian studies have comprehensively compared outcomes after joint replacement up to 1 year . This paper compares the patterns of recovery across physical and patient-centred outcomes following knee or hip replacement in an Australian cohort . One hundred and twenty-two consecutive patients undergoing knee or hip replacement were prospect ively followed . Serial assessment s were conducted ( preoperatively , and 2 , 6 , 12 , 26 and 52 weeks post-surgery ) . Joint pain , patient 's global improvement , timed mobility , and complications were monitored . English-proficient patients completed WOMAC ( Western Ontario and McMaster Universities Osteoarthritis Index ) and SF-36v2 ( Medical Outcomes Short-Form 36 version 2 ) question naires . At 1 year , 81 % ( 55 knee , 44 hip ) were available for follow-up . Significant , large improvements ( up to 254 % ) were evident for most outcomes . Global improvement was reported by 97 % . Recovery for both surgical groups was greatest within the first 26 weeks , but hip patients improved more quickly in most outcomes . Wound disturbances were the most common complication ( 23 in total , 23 % ) and 13 patients ( 13 % ) were readmitted for complications . Recovery patterns were similar to that observed elsewhere . The physical and patient-centred outcomes provide a useful Australian reference for clinicians of the temporal aspects of recovery as well the differences between hip and knee surgeries . Complication and readmission rates appeared high , possibly partly explained by the rigorous capture method Objectives To assess how costs and quality of life ( measured by EuroQoL-5 Dimensions ( EQ-5D ) ) before and after total hip replacement ( THR ) and total knee replacement ( TKR ) vary with age , gender and preoperative Oxford hip score ( OHS ) and Oxford knee score ( OKS ) . Design Regression analyses using prospect ively collected data from clinical trials , cohort studies and administrative data bases . Setting UK secondary care . Participants Men and women undergoing primary THR or TKR . The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years . The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years . The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year . Outcome measures EQ-5D-3L quality of life before and after surgery , costs of primary arthroplasty , costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement . Results Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile . The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10 . However , postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44 . In contrast , costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS . For example , costs of hospital readmissions within 12 months after primary THR/TKR were £ 740/£888 for patients at the 5th percentile compared with £ 314/£404 at the 95th percentile of the OHS/OKS distribution . Conclusions Our findings suggest that costs and quality of life associated with total joint replacement vary systematic ally with preoperative symptoms measured by OHS/OKS
Physical activity did not change at 6 months , and a small to moderate improvement was found at 12 months postsurgery , despite large improvements in quality of life , pain , and physical function .
Reasons for the lack of increased PA are unknown but may be behavioral in nature , as a sedentary lifestyle is difficult to change .
OBJECTIVE Little is known about the extent to which  physical activity ( PA )  levels change following total knee or hip joint replacement relative to pain , physical function , and quality of life .
Our objective was to conduct a systematic review and meta- analysis on changes in PA relative to pain , quality of life , and physical function  after total knee or hip joint replacement .