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About 33% patients with osteoarthritis undergoing total hip/knee arthroplasty are not satisfied with the outcome, warranting the need to improve patient selection. Handgrip strength (HGS) has been suggested as a proxy for overall muscle strength and may be associated with post-arthroplasty function. This study aims to assess the association of pre-operative HGS with change in hip/knee function and quality of life in patients with arthroplasty. 226 hip (THA) and 246 knee (TKA) arthroplasty patients were included in this prospective cohort study. Pre-operative HGS was assessed by means of a dynamometer and the HOOS/KOOS and SF-36 questionnaires were collected before arthroplasty and 1 year thereafter. The association of HGS with score change on each sub-domain of the included questionnaires was assessed by linear regression models, adjusting for sex, body mass index and baseline score. Mean pre-operative HGS was 26 kg for patients undergoing THA and 24 kg for those undergoing TKA. HGS was positively associated with an increased improvement score on “function in sport and recreation”-domain in hip (β = 0.68, P = 0.005) and knee (β = 0.52, P = 0.049) and “symptoms”-domain in hip (β = 0.56, P = 0.001). For patients with THA, HGS was associated with the “quality of life” domain (β = 0.33, P = 0.033). In patients with TKA, HGS was associated with the physical component score (β = 0.31, P = 0.001). All statistically significant effects were positive, indicating that with greater pre-operative HGS, an increased gain in 1-year post-surgery score was observed. HGS can be used as a tool to inform patients with OA who are future candidates for a prosthesis about the possible improvements of certain aspects of life after arthroplasty.

Background and purpose — There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods — This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results — Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation — The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA.

The aim of the study was to examine the relationship between comorbidities and pain, physical function and health-related quality of life (HRQoL) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A cross-sectional retrospective survey was conducted including 19 specific comorbidities, administered in patients who underwent THA or TKA in the previous 7–22 months in one of 4 hospitals. Outcome measures included pain, physical functioning, and HRQoL. Of the 521 patients (281 THA and 240 TKA) included, 449 (86 %) had ≥1 comorbidities. The most frequently reported comorbidities (>15 %) were severe back pain; neck/shoulder pain; elbow, wrist or hand pain; hypertension; incontinence of urine; hearing impairment; vision impairment; and cancer. Only the prevalence of cancer was significantly different between THA (n = 38; 14 %) and TKA (n = 52; 22 %) (p = 0.01). The associations between a higher number of comorbidities and worse outcomes were stronger in THA than in TKA. In multivariate analyses including all comorbidities with a prevalence of >5 %, in THA dizziness in combination with falling and severe back pain, and in TKA dizziness in combination with falling, vision impairments, and elbow, wrist or hand pain was associated with worse outcomes in most of the analyses. A broad range of specific comorbidities needs to be taken into account with the interpretation of patients’ health status after THA and TKA. More research including the ascertainment of comorbidities preoperatively is needed, but it is conceivable that in particular, the presence of dizziness with falling, pain in other joints, and vision impairments should be assessed and treated in order to decrease the chance of an unfavorable outcome.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) bring relief of pain and functional disability to patients with end-stage osteoarthritis, and however, the literature on their impact on patients’ level of physical activity (PA) is scarce. Cross-sectional study in patients who underwent THA/TKA surgery in the preceding 6–22 months and a random sample of persons aged >40 years from the Dutch general population, participating in a national survey. PA in minutes per week (min/week) and adherence to the Dutch recommendation for PA (NNGB yes/no) were measured by the short questionnaire to assess health-enhancing PA. Multivariable linear (total min/week) and logistic regression analyses (meeting recommendations PA), adjusting for confounders, were performed for THA and TKA separately. In total, 258 THA [62.3% female, aged 69.4 (9.1)] and 221 TKA [65.7% female, aged 69.5 (8.9)] patients and 4373 persons from the Dutch general population [51.4% female, aged 58.9 (11.6)] were included. The presence of THA was associated after adjusting for age, sex, BMI education and musculoskeletal comorbidities, with more total min/week spent on PA (THA 13.8% increase, 95% CI 1.6–27.6%), whilst both TJA groups were associated with adhering to NNGB (THA: OR 1.79, 95% CI 1.26–2.56; TKA: OR 1.73, 95% CI 1.20–2.51). As this study used questionnaires to compare the PA of THA/TKA patients to the general population, some recall and selection bias might have been induced. After surgery, overall, TJA patients are more likely to adhere NNGB than a representative sample of persons >40 years from the Dutch general population.

The aim of this study was to measure return to work and duration until return to work in patients undergoing total hip or knee arthroplasty (THA or TKA). This prospective study included patients under 65 years of age, undergoing THA or TKA, who provided information on their work status preoperatively (paid work yes/no and working hours) and 1 year thereafter (paid work yes/no, working hours and time until return to work). Seventy-one THA and 64 TKA patients had a paid job preoperatively. The employment rates 1 year postoperatively were 64/71 (90 %) after THA and 53/64 (83 %) after TKA. Of those who returned to work, 9/64 (14 %) of THA patients and 10/53 (19 %) of TKA patients worked less hours than preoperatively [mean decrease of 16 (SD 11.5) and 14 (SD 13.0) hours, respectively]. The mean time to return to work was 12.5 (SD 7.6) and 12.9 (SD 8.0) weeks in THA and TKA, respectively. The majority of working patients who underwent THA or TKA returned to work, after approximately 12 weeks. A considerable proportion of the patients returning to work worked less hours than preoperatively. More research into patients who do not return or decrease their working hours is needed.

Objectives: The constructs optimism, pessimism, hope, treatment credibility and treatment expectancy are associated with outcomes of medical treatment. While these constructs are grounded in different theoretical models, they nonetheless show some conceptual overlap. The purpose of this study was to examine whether currently available measurement instruments for these constructs capture the conceptual differences between these constructs within a treatment setting. Methods: Patients undergoing Total Hip and Total Knee Arthroplasty (THA and TKA) (Total N = 361; 182 THA; 179 TKA), completed the Life Orientation Test-Revised for optimism and pessimism, the Hope Scale, the Credibility Expectancy Questionnaire for treatment credibility and treatment expectancy. Confirmatory factor analysis was used to examine whether the instruments measure distinct constructs. Four theory-driven models with one, two, four and five latent factors were evaluated using multiple fit indices and Δχ2 tests, followed by some posthoc models. Results: The results of the theory driven confirmatory factor analysis showed that a five factor model in which all constructs loaded on separate factors yielded the most optimal and satisfactory fit. Posthoc, a bifactor model in which (besides the 5 separate factors) a general factor is hypothesized accounting for the commonality of the items showed a significantly better fit than the five factor model. All specific factors, except for the hope factor, showed to explain a substantial amount of variance beyond the general factor. Conclusion: Based on our primary analyses we conclude that optimism, pessimism, hope, treatment credibility and treatment expectancy are distinguishable in THA and TKA patients. Postdoc, we determined that all constructs, except hope, showed substantial specific variance, while also sharing some general variance.

Background In the large majority of patients with severe hip and knee osteoarthritis (OA) pain, physical functioning and quality of life improve significantly after total hip arthroplasty (THA) or total knee arthroplasty (TKA). In a subgroup of patients the outcomes are however less favorable, with comorbidity being identified as one of the contributing factors. Objectives To describe the associations between the total number and nature of specific comorbidities, and pain, physical functioning and quality of life after THA or TKA. Methods In this cross-sectional survey 521 patients with hip or knee OA who underwent THA (n=281) or TKA (n=240) in the previous 5-22 months were recruited from 4 hospitals. Patients9 characteristics; information on comorbidities (19-item questionnaire); pain and physical functioning (subscores of the Hip disability and Knee injury Osteoarthritis Outcome Score (H/KOOS); and quality of life (SF 36 physical and mental component summary scores; PCS and MCS) were collected by means of a paper questionnaire. Descriptive statistics and multivariate regression analyses have been performed. Results Patients9characteristics were: female 336 (65%); mean age 70.0 (SD 9.3) years; mean BMI 27.8 (SD 4.7); mean H/KOOS pain score 81.7 (SD 19.1); mean H/KOOS physical functioning score 78.9 (SD 20.9); and SF 36 PCS and MCS 45.4 (SD 8.6) and 47.7 (SD 7.7), respectively. The BMI was significantly higher, and pain and physical functioning scores were significantly worse in TKA patients than in THA patients. Overall 449 (86%) patients reported one or more comorbidities. Concerning the presence of specific comorbidities, hypertension and hearing impairments in a group conversation were the 2 most frequently reported comorbidities (>25% for the total group). Severe back pain; severe neck/shoulder pain; severe elbow, wrist or hand pain; cancer; urinary incontinence; and vision impairments were reported by 15-25% of the patients in the total group. The proportion of patients with 5 or more comorbidities was higher in patients with TKA as compared to THA (47 (20%) and 37 (13%), respectively (p=0.047)). In the total group of participants the presence of 5 or more comorbidities was significantly associated with all 4 outcomes in a multivariate regression analysis adjusting for age, sex, BMI and type of surgery (THA or TKA). Using multivariate regression models including all 19 comorbidities and the same confounders, the presence of dizziness with falling (reported by 6%) and severe back pain (reported by 19%) were each independently and significantly associated with 3 of the 4 outcomes. Conclusions The present study showed that in patients who underwent THA or TKA, in particular the presence of 5 or more comorbidities contributes to more pain and worse physical functioning within the first 2 years after surgery. Notably, the presence of dizziness with falling and severe back pain appeared to have a considerable negative impact. These findings underline the need for a careful preoperative assessment of a large range of individual comorbidities. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3683

Background A substantial proportion of patients undergoing Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) is of working age at the time of surgery. Although it is found that the majority of working patients return to work after surgery, the literature on duration until return to work and the impact of surgery on the amount of working hours in patients undergoing THA or TKA is scanty. Objectives The aim of this study was to measure duration until return to work and the impact of surgery on working hours in patients undergoing THA or TKA. Methods This study on work was part of a prospective cohort study on the outcomes of THA and TKA surgeries. This study included patients under 65 years of age, undergoing THA or TKA, who provided information on their work status before and one year after surgery. Assessments included a questionnaire on work status (yes/no), working hours per week and time to return to work. Comparisons of working hours before and after surgery were done with the Wilcoxon signed-rank test. Results Seventy-five of 122 THA (62%) and 70 of 120 TKA patients (59%) who were under 65 years had a paid job before surgery. The mean numbers of working hours per week were 32.3 (SD 13.4) in the THA group and 31.0 (SD 12.6) in the TKA group. Absence of work in relation to hip-or knee complaints during the year before surgery was reported by 19 (25%) and 19 (27%) of the employed patients with THA and TKA, respectively. The employment rates one year postoperatively were 66/75 (88%) after THA and 60/70 (86%) after TKA. The mean time to return to work was 12.5 (SD 7.5) and 12.9 (SD 7.8) weeks after THA and TKA, respectively. After 1 year, 17/66 (30%) of the patients with THA and 19/60 (32%) of patients with TKA worked less hours postoperatively as compared to preoperatively. In these patients, the number of working hours decreased significantly, with a mean difference of -14.4 hours (95% CI -19.5; -9.8) in the THA group and of -14.7 hours (95% CI -20.7; -9.4) in the TKA group (both p=0.002, Wilcoxon signed-rank test). Conclusions The majority of patients who had a paid job before surgery returned to work after THA and TKA, after approximately 12 weeks. Thirty % of the patients who returned to work, worked less hours than preoperatively. Given the increasing numbers of working patients undergoing THA or TKA more research into patients who do not return or decrease their working hours is needed. References Tilbury C. et al. Rheumatology 2013 Nov 23. [Epub ahead of print] Kuijer PP et al. J Occup Rehabil 2009;19(4):375-381. Kievit A.J. et al. Journal of Arthroplasty 2014; 10.1016 Acknowledgements Special thanks to the Annafonds|NOREF for their financial support. Disclosure of Interest : C. Tilbury Grant/research support: Anna Fonds/NOREF, C. Leichtenberg: None declared, R. Tordoir: None declared, M. Holtslag: None declared, S. Verdegaal: None declared, R. Nelissen: None declared, T. Vliet Vlieland: None declared DOI 10.1136/annrheumdis-2014-eular.2940