Recovery in Year Two of Adults After Undergoing TKA and THA: Implications for Understanding Recovery, Care Delivery, and Referral to Community Exercise Programs
Abstract
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are orthopaedic surgeries to manage end-stage osteoarthritis. A year after undergoing TKA or THA, some patients report physical function limitations and unmet physical activity expectations. Limited knowledge of physical function recovery beyond the first year post-surgery is available. To describe physical function recovery in adults during year two after undergoing TKA or THA, two studies were completed using quantitative measures and individual interviews. In both studies, group scores improved significantly for the 30s-CST, and only in the TKA study for the TUG. In both studies, many participants who self-reported improvement at 18-months achieved a minimum clinically important difference (MCID) on the 30s-CST. MCID were achieved only in the TKA study for participants self-reporting improvement at 24-months post-surgery on the TUG, SCT, and 6MWT. In the TKA study, a minority achieved MCID on the OKS, DASI, and UCLA. OHS and UCLA were significantly improved for participants self-reporting improvement at 24-months, but not at the MCID level. Two years after undergoing TKA or THA, all participants reported return to meaningful activity, including community programs, however many returned to light-intensity activities only. In the TKA study, reframing success and acceptance of function aligned with the large range in performance scores. A shift in focus from impairment to living well was a clear transition in recovery in the THA study. A third qualitative study addressed the gap in understanding about how physiotherapists and family physicians refer patients to community exercise programs after undergoing TKA or THA. While all clinicians attempted to connect patients to community-based exercise programs, educated patients on the importance of physical activity post-surgery, and revisited patient readiness to engage in exercise, they often lacked time, knowledge and connection with programs for successful referral. The clinical implications of the findings include that physical function recovery may extend beyond one-year post-surgery, MCID values for performance-based and patient-reported outcome measures are available to assist clinicians with interpretation of patient scores and/or identify patients at risk of decline, and primary care practitioners need support to promote physical function recovery in patients after undergoing TKA or THA.