Abstract
The objective of this study was to compare comorbidity, functional ability, and health care utilization in veterans with total knee arthroplasty (TKA) or total hip arthroplasty (THA) versus matched control populations. A cohort of veterans using Veterans Affairs (VA) healthcare system reported limitations in six activities of daily living (ADLs; bathing, dressing, eating, walking, transferring, and using the toilet), demographics, and physician-diagnosed comorbidity. VA databases provided healthcare utilization and International Classification of Diseases-9/Common procedure terminology codes for TKA/THA. Patients were classified as: (1) primary TKA; (2) primary THA; (3) combination group (≥1 procedure); and (4) control veteran population (no THA/TKA). Multivariable regression analyses compared the risk or counts of ADL limitation and in-/out-patient visits. After multivariable adjustment, TKA, THA or combination groups had significantly higher prevalence of the following compared to veteran controls: arthritis, diabetes, or heart disease (p < 0.0001 each), severe (≥3) ADL limitation (33%, 42%, 42% vs. 24%; p < 0.0001), and annual hospitalization rate (24%, 19%, 26% vs. 16%, p < 0.0001). Annual outpatient surgery visits were more (2.5, 2.3, 2.3 vs. 2, p = 0.01) and risk of any mental health outpatient visit was lower (12%, 11%, 12% vs. 18%, p = 0.0039). All ADLs, except eating, were significantly more limited in arthroplasty groups (p ≤ 0.0009). Severe ADL limitation was more prevalent in veterans with arthroplasty than in two age-matched US cohorts: 13.4 times in ≥65 years; and 1.2-, 1.6-, and 4-fold in ≥85, 75–84, and 65–74 years. Poorer function and higher comorbidity and utilization in veterans with TKA/THA suggest that this group is appropriate for interventions targeted at improving function and decreasing utilization.
Similar content being viewed by others
References
Callahan CM, Drake BG, Heck DA, Dittus RS (1994) Patient outcomes following tricompartmental total knee replacement. A meta-analysis. Jama 271(17):1349–1357
Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974
Hakkinen A, Ylinen J, Rinta-Keturi M, Talvitie U, Kautiainen H, Rissanen A (2004) Decreased neck muscle strength is highly associated with pain in cervical dystonia patients treated with botulinum toxin injections. Arch Phys Med Rehabil 85(10):1684–1688
Kazis LE, Miller DR, Clark J, Skinner K, Lee A, Rogers W et al (1998) Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med 158(6):626–632
Kou B, Perner K, Yuan Y (2001) Primary Zweymuller total hip arthroplasty for osteoarthritis secondary to congenital acetabular dysplasia. Zhonghua Wai Ke Za Zhi 39(8):623–625
Wells V, Hearn T, Heard A, Lange K, Rankin W, Graves S (2006) Incidence and outcomes of knee and hip joint replacement in veterans and civilians. ANZ J Surg 76(5):295–299
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785
Antoniou J, Martineau PA, Filion KB, Haider S, Zukor DJ, Huk OL et al (2004) In-hospital cost of total hip arthroplasty in Canada and the United States. J Bone Joint Surg Am 86-A(11):2435–2439
Kane RL, Saleh KJ, Wilt TJ, Bershadsky B (2005) The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am 87(8):1719–1724
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2000) Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 27(7):1745–1752
Linsell L, Dawson J, Zondervan K, Rose P, Carr A, Randall T et al (2006) Pain and overall health status in older people with hip and knee replacement: a population perspective. J Public Health (Oxf) 28(3):267–273
Heck DA, Maar DC, Lowdermilk GA, Kalasinski LA, Mesko JW (1992) Comparative analysis of total knee arthroplasty in two health care delivery systems. J Arthroplasty 7(1):93–100
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP et al (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36
Elson DW, Brenkel IJ (2006) Predicting pain after total knee arthroplasty. J Arthroplasty 21(7):1047–1053
Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86-A(10):2179–2186
Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM (2000) Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med 160(21):3252–3257
Weaver F, Hynes D, Hopkinson W, Wixson R, Khuri S, Daley J et al (2003) Preoperative risks and outcomes of hip and knee arthroplasty in the Veterans Health Administration. J Arthroplasty 18(6):693–708
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D et al (1999) Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 42(8):1722–1728
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2001) The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med 161(3):454–460
MacWilliam CH, Yood MU, Verner JJ, McCarthy BD, Ward RE (1996) Patient-related risk factors that predict poor outcome after total hip replacement. Health Serv Res 31(5):623–638
Perlin JB, Kolodner RM, Roswell RH (2004) The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care 10(11 Pt 2):828–836
Fleming C, Fisher ES, Chang CH, Bubolz TA, Malenka DJ (1992) Studying outcomes and hospital utilization in the elderly. The advantages of a merged data base for Medicare and Veterans Affairs hospitals. Med Care 30(5):377–391
Singh JA, Sloan JA (2008) Health-related quality of life in veterans with prevalent total knee arthroplasty and total hip arthroplasty. Rheumatology (Oxford) 47(12):1826–1831
Singh JA, Borowsky SJ, Nugent S, Murdoch M, Zhao Y, Nelson DB et al (2005) Health-related quality of life, functional impairment, and healthcare utilization by veterans: veterans' quality of life study. J Am Geriatr Soc 53(1):108–113
Katz S, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in aged: The index of ADL: A standard measure of biological and psychological function. JAMA 185:914–919
Dunlop DD, Semanik P, Song J, Manheim LM, Shih V, Chang RW (2005) Risk factors for functional decline in older adults with arthritis. Arthritis Rheum 52(4):1274–1282
Hamman RF, Mulgrew CL, Baxter J, Shetterly SM, Swenson C, Morgenstern NE (1999) Methods and prevalence of ADL limitations in Hispanic and non-Hispanic white subjects in rural Colorado: the San Luis Valley Health and Aging Study. Ann Epidemiol 9(4):225–235
Dunlop DD, Manheim LM, Sohn MW, Liu X, Chang RW (2002) Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 83(7):964–971
Kashner TM (1998) Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care 36(9):1324–1336
Szeto HC, Coleman RK, Gholami P, Hoffman BB, Goldstein MK (2002) Accuracy of computerized outpatient diagnoses in a Veterans Affairs general medicine clinic. Am J Manag Care 8(1):37–43
Weidner C, Klede M, Rukwied R, Lischetzki G, Neisius U, Skov PS et al (2000) Acute effects of substance P and calcitonin gene-related peptide in human skin–a microdialysis study. J Invest Dermatol 115(6):1015–1020
Mor V, Wilcox V, Rakowski W, Hiris J (1994) Functional transitions among the elderly: patterns, predictors, and related hospital use. Am J Public Health 84(8):1274–1280
Stump TE, Dexter PR, Tierney WM, Wolinsky FD (1995) Measuring patient satisfaction with physicians among older and diseased adults in a primary care municipal outpatient setting. An examination of three instruments. Med Care 33(9):958–972
Severson MA, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Ivnik RJ et al (1994) Patterns and predictors of institutionalization in community-based dementia patients. J Am Geriatr Soc 42(2):181–185
Keller BK, Potter JF (1994) Predictors of mortality in outpatient geriatric evaluation and management clinic patients. J Gerontol 49(6):M246–M251
Reuben DB, Rubenstein LV, Hirsch SH, Hays RD (1992) Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 93(6):663–669
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by NIH CTSA Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research)
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
Rights and permissions
About this article
Cite this article
Singh, J.A., Sloan, J. Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty. Clin Rheumatol 28, 1025–1033 (2009). https://doi.org/10.1007/s10067-009-1201-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1201-4