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Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty
Clinical Rheumatology, 06/18/09

Singh JA et al. - Study reports poorer function and higher comorbidity and utilization in veterans with total knee arthroplasty/total hip arthroplasty (TKA/THA), suggesting that this group is appropriate for interventions targeted at improving function and decreasing utilization.

• Comparison of comorbidity, functional ability, and health care utilization in veterans with TKA or THA vs matched control populations
• A cohort of veterans reported limitations in 6 activities of daily living, demographics, and physician-diagnosed comorbidity
• Patients were classified as:
  1. Primary total knee arthroplasty (TKA)
  2. Primary total hip arthroplasty (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

• TKA, THA or combination groups had higher prevalence of the following, compared to veteran controls:
  • arthritis, diabetes, or heart disease
  • severe (≥3) ADL limitation (33%, 42%, 42% vs 24%) and
  • annual hospitalization rate (24%, 19%, 26% vs 16%)
• Annual outpatient surgery visits were more and risk of any mental health outpatient visit was lower
• All ADLs, except eating, were more limited in arthroplasty groups
• 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 respectively

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