Rheumatology Advance Access originally published online on October 16, 2008
Rheumatology 2008 47(12):1826-1831; doi:10.1093/rheumatology/ken381
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© Published by Oxford University Press on behalf of the British Society for Rheumatology 2008.
Health-related quality of life in veterans with prevalent total knee arthroplasty and total hip arthroplasty
1Rheumatology Section and Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, 2Division of Rheumatology, Department of Medicine, University of Minnesota, Minneapolis, 3Department of Health Sciences, Orthopaedic Surgery and 4Department of Biostatistics, Mayo Clinic School of Medicine, Rochester, MN, USA.
Correspondence to: J. A. Singh, Minneapolis VA Medical Center, Rheumatology (111R), One Veteran's Drive, Minneapolis, MN 55417, USA. E-mail: Jasvinder.md{at}gmail.com
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Abstract |
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Objective. To study the HRQOL in veterans with prevalent total knee arthroplasty (TKA) or total hip arthroplasty (THA) and compare them with age- and gender-matched US population and control veteran population without these procedures.
Methods. A cohort study and cross-sectional survey on veterans obtained demographics and HRQOL with Short-Form 36 for veterans (SF-36V). Veterans were categorized into: primary TKA; primary THA; combination group (
1 primary and/or any revision TKA/THA); and control population (no THA/TKA). Multivariable regression compared the physical and mental component summary scores (PCS and MCS scores, respectively) in each group.
Results. Response rate was 58% (40 508/70 334): 531 with TKA, 254 with THA, 461 constituted the combination and 39 262, the control group. Mean PCS scores in veterans with THA, TKA, and combination group were 2 S.D. lower than the US mean (29.5 ± 0.8; 30.1 ± 1.1 and 27.1 ± 0.8). MCS scores were similar to the US mean (47.3 ± 0.9; 49.1 ± 1.2 and 45.6 ± 0.9). Compared with controls, significantly more veterans in TKA, THA or combination groups had multivariable-adjusted PCS 
30 (55, 64, 71 and 76%; P < 0.0001); similar proportion had MCS 30 (15, 12, 8 and 16%; P = 0.29); and mean scores on SF-36 physical domains (P 0.0011), but not mental/emotional domains (P 0.01) were statistically and clinically lower.
Conclusions. Profound physical HRQOL deficits exist in veterans with TKA/THA and in combination group compared with age- and gender-matched general US population and with veteran controls. In these groups, these deficits are not attributable to differences in sociodemographics, comorbidity and healthcare access/utilization. Arthroplasty status may be a surrogate for poorer HRQOL and worse outcomes. Future studies are indicated to determine HRQOL deficit causes and interventions to improve HRQOL in patients with arthroplasty.
KEY WORDS: Health related quality of life, Veterans, Total knee arthroplasty, Total hip arthroplasty
Submitted 18 May 2008;
revised version accepted 26 August 2008.
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