Introduction
The number of patients who will undergo joint replacement of the shoulder, hip, and knee is expected to increase drastically in the next decade. While previous studies have examined patient satisfaction and postoperative recovery following total joint arthroplasty, no study has compared patient satisfaction and postoperative recovery in a single patient who has undergone total arthroplasty of the shoulder, hip, and knee. The purpose of this study is to determine which joint arthroplasty results in the greatest improvement in quality of life and provides the least painful and difficult recovery.
Methods
Patients diagnosed with arthritis who electively underwent at least one total shoulder arthroplasty (TSA), total knee arthroplasty (TKA) and total hip arthroplasty (THA) over an eighteen-year period, 2000-2018, were identified and included in our analysis. Patients were contacted over the phone to complete the Modified Harris Hip Score (mHHS), the Knee Injury and Osteoarthritis Outcome for Joint Replacement (KOOS Jr.), and the American Shoulder and Elbow Surgeons (ASES) Score as well as a custom satisfaction survey designed to elicit their subjective surgical preferences.
Results
Sixty-three patients (28 males, 44.4%) met the inclusion criteria and were available for analysis. The mean age at the time of total shoulder arthroplasty was 65.9 ± 9.0 years (range, 28 - 81). The mean follow-up after TSA was 6.62 ± 4.14 years (range, 2.04 - 19.05). The mean age at time of total hip arthroplasty was 65.4 ± 9.0 years (range, 27 - 79). The mean follow-up after THA was 7.01 ± 4.08 years (mean, 2.00 - 17.95). The mean age at the time of total knee arthroplasty was 65.5 ± 8.5 years (range, 35 - 82). The mean follow-up after TKA was 7.23 ± 3.90 years (2.00 - 19.23). The average postoperative functional outcome scores for the KOOS, Jr., ASES, and mHHS were 80.59, 82.37 and 83.73, respectively. The results of our custom survey demonstrated that the majority of patients (57.1%) reported that all three surgeries had an equally dramatic improvement on their quality of life followed by THA (17.5%), TSA (14.3%) and TKA (7.9%). With regards to greatest pain relief, the majority of patients again responded that all three surgeries equally improved their pain relief (39.7%) which was closely followed by THA (28.6%), TSA (19.0%), and TKA (11.1%). Notably, TKA was reported to be the most painful and difficult surgery in terms of recovery according to 55.6% and 49.2% of the respondents, respectively. Overall, the majority of patients reported that they would still recommend all three surgeries to friends and family (52.4%) and did not regret any of the surgeries (65.1%).
Conclusion
The results of our study indicate that elective multiple joint arthroplasty indicated for debilitating arthritis does in fact provide highly satisfactory subjective outcomes for the majority of patients. At the same time, our survey revealed that TKA may be uniquely challenging for patients in terms of recovery and thus closely monitored rehabilitation is warranted. Further investigation into the post-operative course and rehabilitation of these three major arthroplasties is required.