The Journal of Bone and Joint Surgery (American) 86:963-974 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Health-Related Quality of Life in Total Hip and Total Knee Arthroplasty
A Qualitative and Systematic Review of the Literature
Olivier Ethgen, PhD1,
Olivier Bruyère, MSc1,
Florent Richy, MSc1,
Charles Dardennes, MD1 and
Jean-Yves Reginster, MD2
1 WHO Collaborating Center for Public Health Aspects of Osteoarticular Diseases
(O.E. and O.B.) and Department of Public Health, Epidemiology, and Health
Economics (F.R. and C.D.), University of Liège, Belgium, CHU Sart
Tilman–Bâtiment B23, 4000 Liège, Belgium. E-mail address
for O. Ethgen:
o.ethgen{at}ulg.ac.be
2 Bone and Cartilage Research Unit, University of Liège, CHU Centre
Ville–Bâtiment K1, Quai G. Kurth 45, 4020 Liège,
Belgium
Investigation performed at the WHO Collaborating Center for Public
Health Aspects of Osteoarticular Diseases, Department of Public Health,
Epidemiology, and Health Economics, and Bone and Cartilage Research Unit,
University of Liège, Belgium
The authors did not receive grants or outside funding in support of their
research or preparation of this manuscript. They did not receive payments or
other benefits or a commitment or agreement to provide such benefits from a
commercial entity. No commercial entity paid or directed, or agreed to pay or
direct, any benefits to any research fund, foundation, educational
institution, or other charitable or nonprofit organization with which the
authors are affiliated or associated.
Background: Total hip and total knee arthroplasties are well
accepted as reliable and suitable surgical procedures to return patients to
function. Health-related quality-of-life instruments have been used to
document outcomes in order to optimize the allocation of resources. The
objective of this study was to review the literature regarding the outcomes of
total hip and knee arthroplasties as evaluated by health-related
quality-of-life instruments.
Methods: The Medline and EMBASE medical literature databases were
searched, from January 1980 to June 2003, to identify relevant studies.
Studies were eligible for review if they met the following criteria: (1) the
language was English or French, (2) at least one well-validated and
self-reported health-related quality of life instrument was used, and (3) a
prospective cohort study design was used.
Results: Of the seventy-four studies selected for the review,
thirty-two investigated both total hip and total knee arthroplasties,
twenty-six focused on total hip arthroplasty, and sixteen focused on total
knee arthroplasty exclusively. The most common diagnosis was osteoarthritis.
The duration of follow-up ranged from seven days to seven years, with the
majority of studies describing results at six to twelve months. The Short
Form-36 and the Western Ontario and McMaster University Osteoarthritis Index,
the most frequently used instruments, were employed in forty and twenty-eight
studies, respectively. Seventeen studies used a utility index. Overall, total
hip and total knee arthroplasties were found to be quite effective in terms of
improvement in health-related quality-of-life dimensions, with the occasional
exception of the social dimension. Age was not found to be an obstacle to
effective surgery, and men seemed to benefit more from the intervention than
did women. When improvement was found to be modest, the role of comorbidities
was highlighted. Total hip arthroplasty appears to return patients to function
to a greater extent than do knee procedures, and primary surgery offers
greater improvement than does revision. Patients who had poorer preoperative
health-related quality of life were more likely to experience greater
improvement.
Conclusions: Health-related quality-of-life data are valuable, can
provide relevant health-status information to health professionals, and should
be used as a rationale for the implementation of the most adequate standard of
care. Additional knowledge and scientific dissemination of surgery outcomes
should help to ensure better management of patients undergoing total hip or
total knee arthroplasty and to optimize the use of these procedures.
Level of Evidence: Therapeutic study, Level III-3
(systematic review of Level-III studies). See Instructions to Authors for a
complete description of levels of evidence.
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