Profile of osteoarthritic patients undergoing hip or knee arthroplasty, a step toward a definition of the “need for surgery”

Aims The objective of this study is to characterize, based
on clinical, radiographic, health-related, quality-of-liferelated,
and demographic variables, the profile of a large,
homogeneous, cohort of patients undergoing knee or hip
arthroplasty, in a public hospital. Current regulatory guidelines
for structure-modifying agent are not clear regarding
hard clinical endpoint. The “need for surgery” has been
suggested as a potential relevant outcome, but, until now,
it is poorly defined. By characterizing a large number of
patients who undergo total hip or total knee replacement,
this paper aims at providing a contribution to the better
definition of the “need for surgery” in advanced OA of the
lower limbs.
Methods Consecutive patients who underwent primary
knee arthroplasty (KA) or hip arthroplasty (HA) between
December 2008 and February 2013, in an academic hospital,
and who were diagnosed with hip or knee osteoarthritis
(OA) (ACR criteria). Data collected at baseline
included demographic and clinical data; Kellgren–Lawrence
radiological grading; Western Ontario and Mc Master Universities Arthritis Index (WOMAC); EuroQol
five dimensions questionnaire and EuroQol visual analog
scale; and 36-item Short Form Health Survey.
Results 626 subjects were included, 346 with hip OA and
280 with knee OA. Significant differences between subjects
in need of an HA or of a KA were seen in terms of
age (66.5 years versus 65 for hip), duration of complaints
(2188 days versus 1146.5 for hip), BMI (28.68 kg/m² versus
27.07), radiological status (severe OA were found in
79.85% in knee group and 68.73% in hip group), comorbidities
(FCI higher in knee group), traumatic of surgical
history (37 versus 6%), and health-related quality of life
and function (patients with HA had a poorer clinical status
regarding WOMAC and WOMAC subscale).
Conclusion Significant differences were observed
between patients undergoing KA or HA. These differences
might be useful to better understand the “need for surgery”
status in these indications. This concept may help to define
responders and failures to pharmacological treatment of
OA.