The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement

L. Gossec; S. Paternotte; J. F. Maillefert; C. Combescure; P. G. Conaghan; A. M. Davis; K. P. Gunther; G. Hawker; M. Hochberg; J. N. Katz; M. Kloppenburg; K. Lim; L. S. Lohmander; N. N. Mahomed; L. March; K. Pavelka; L. Punzi; E. M. Roos; L. Sanchez-Riera; J. A. Singh; M. E. Suarez-Almazor; M. Dougados

doi:10.1016/j.joca.2010.10.025

The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement

L. Gossec, S. Paternotte, J. F. Maillefert, C. Combescure, P. G. Conaghan, A. M. Davis, K. P. Gunther, G. Hawker, M. Hochberg, J. N. Katz, M. Kloppenburg, K. Lim, L. S. Lohmander, N. N. Mahomed, L. March, K. Pavelka, L. Punzi, E. M. Roos, L. Sanchez-Riera, J. A. SinghM. E. Suarez-Almazor, M. Dougados

Research output: Contribution to journal › Article › peer-review

154 Scopus citations

Abstract

Objective: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). Methods: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100). Analyses: Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR. Results: In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P< 0.0001], there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'. Conclusion: Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon.

Original language	English (US)
Pages (from-to)	147-154
Number of pages	8
Journal	Osteoarthritis and Cartilage
Volume	19
Issue number	2
DOIs	https://doi.org/10.1016/j.joca.2010.10.025
State	Published - Feb 2011

Keywords

Hip
Joint replacement
Knee
Osteoarthritis
Surgery
Symptom

ASJC Scopus subject areas

Rheumatology
Biomedical Engineering
Orthopedics and Sports Medicine

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Gossec, L., Paternotte, S., Maillefert, J. F., Combescure, C., Conaghan, P. G., Davis, A. M., Gunther, K. P., Hawker, G., Hochberg, M., Katz, J. N., Kloppenburg, M., Lim, K., Lohmander, L. S., Mahomed, N. N., March, L., Pavelka, K., Punzi, L., Roos, E. M., Sanchez-Riera, L., ... Dougados, M. (2011). The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthritis and Cartilage, 19(2), 147-154. https://doi.org/10.1016/j.joca.2010.10.025

The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. / Gossec, L.; Paternotte, S.; Maillefert, J. F. et al.
In: Osteoarthritis and Cartilage, Vol. 19, No. 2, 02.2011, p. 147-154.

Research output: Contribution to journal › Article › peer-review

Gossec, L, Paternotte, S, Maillefert, JF, Combescure, C, Conaghan, PG, Davis, AM, Gunther, KP, Hawker, G, Hochberg, M, Katz, JN, Kloppenburg, M, Lim, K, Lohmander, LS, Mahomed, NN, March, L, Pavelka, K, Punzi, L, Roos, EM, Sanchez-Riera, L, Singh, JA, Suarez-Almazor, ME & Dougados, M 2011, 'The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement', Osteoarthritis and Cartilage, vol. 19, no. 2, pp. 147-154. https://doi.org/10.1016/j.joca.2010.10.025

Gossec L, Paternotte S, Maillefert JF, Combescure C, Conaghan PG, Davis AM et al. The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthritis and Cartilage. 2011 Feb;19(2):147-154. doi: 10.1016/j.joca.2010.10.025

Gossec, L. ; Paternotte, S. ; Maillefert, J. F. et al. / The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis : An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. In: Osteoarthritis and Cartilage. 2011 ; Vol. 19, No. 2. pp. 147-154.

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title = "The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement",

abstract = "Objective: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). Methods: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100). Analyses: Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR. Results: In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P< 0.0001], there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'. Conclusion: Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon.",

keywords = "Hip, Joint replacement, Knee, Osteoarthritis, Surgery, Symptom",

author = "L. Gossec and S. Paternotte and Maillefert, {J. F.} and C. Combescure and Conaghan, {P. G.} and Davis, {A. M.} and Gunther, {K. P.} and G. Hawker and M. Hochberg and Katz, {J. N.} and M. Kloppenburg and K. Lim and Lohmander, {L. S.} and Mahomed, {N. N.} and L. March and K. Pavelka and L. Punzi and Roos, {E. M.} and L. Sanchez-Riera and Singh, {J. A.} and Suarez-Almazor, {M. E.} and M. Dougados",

note = "Funding Information: This work was supported by unrestricted grants from both scientific societies (OARSI and OMERACT) and pharmaceutical companies: Pfizer, Expansciences, Novartis, Negma Lerads, Rottapharm, Fidia and Pierre Fabre Sant{\'e} laboratories). LSL was supported by the Swedish Research Council. JAS was supported by the National Institute of Health (NIH) Clinical Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research). MSA holds a K24 award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and is partially supported by the Agency for Healthcare Research and Quality through funding of the Houston Center for Education and Research on Therapeutics (CERT). LSR was supported by the Fundaci{\'o}n Espa{\~n}ola de Reumatolog{\'i}a. Funding Information: JAS has received speaker honoraria from Abbott; research and travel grants from Allergan, Takeda, Savient, Wyeth and Amgen ; and consultant fees from Savient and URL pharmaceuticals . ",

year = "2011",

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doi = "10.1016/j.joca.2010.10.025",

language = "English (US)",

volume = "19",

pages = "147--154",

journal = "Osteoarthritis and Cartilage",

issn = "1063-4584",

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T1 - The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis

T2 - An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement

AU - Gossec, L.

AU - Paternotte, S.

AU - Maillefert, J. F.

AU - Combescure, C.

AU - Conaghan, P. G.

AU - Davis, A. M.

AU - Gunther, K. P.

AU - Hawker, G.

AU - Hochberg, M.

AU - Katz, J. N.

AU - Kloppenburg, M.

AU - Lim, K.

AU - Lohmander, L. S.

AU - Mahomed, N. N.

AU - March, L.

AU - Pavelka, K.

AU - Punzi, L.

AU - Roos, E. M.

AU - Sanchez-Riera, L.

AU - Singh, J. A.

AU - Suarez-Almazor, M. E.

AU - Dougados, M.

N1 - Funding Information: This work was supported by unrestricted grants from both scientific societies (OARSI and OMERACT) and pharmaceutical companies: Pfizer, Expansciences, Novartis, Negma Lerads, Rottapharm, Fidia and Pierre Fabre Santé laboratories). LSL was supported by the Swedish Research Council. JAS was supported by the National Institute of Health (NIH) Clinical Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research). MSA holds a K24 award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and is partially supported by the Agency for Healthcare Research and Quality through funding of the Houston Center for Education and Research on Therapeutics (CERT). LSR was supported by the Fundación Española de Reumatología. Funding Information: JAS has received speaker honoraria from Abbott; research and travel grants from Allergan, Takeda, Savient, Wyeth and Amgen ; and consultant fees from Savient and URL pharmaceuticals .

PY - 2011/2

Y1 - 2011/2

N2 - Objective: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). Methods: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100). Analyses: Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR. Results: In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P< 0.0001], there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'. Conclusion: Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon.

AB - Objective: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). Methods: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100). Analyses: Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR. Results: In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P< 0.0001], there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'. Conclusion: Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon.

KW - Hip

KW - Joint replacement

KW - Knee

KW - Osteoarthritis

KW - Surgery

KW - Symptom

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The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: An international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement

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