A Comparative study of Functional Outcomes, And Complications of Total Knee Replacement in Post-Traumatic Osteoarthritis V/S Primary Knee Osteoarthritis.

Abstract

Background: Post-traumatic osteoarthritis (PTOA) occurs after fracture-related trauma around the knee or in the case of ligamentous injuries, and is a significant contributor to pain, stiffness and functional disability. Primary OA (Primary osteoarthritis), however, is a degenerative joint disease that tends to affect the elderly and is not associated with a preceding traumatic event. Although end-stage osteoarthritis is an indication for total knee replacement (TKR), patients with PTOA may experience a different outcome from those patients with Primary OA because of differences in patient characteristics, prior knee trauma, complexity of surgery, and other comorbidities. While there are international studies that compare outcomes of these groups, few local studies are available on functional recovery following TKR in Pakistan.

Objective: To compare objective postoperative outcomes (pain, stiffness, physical function and total WOMAC score) of patients with PTOA and primary osteoarthritis who undergo TKA.

Methods: The methodology of this comparative study will be done in Orthopaedic Department of the selected tertiary care hospital. Patients with post-traumatic osteoarthritis and primary osteoarthritis who are undergoing primary total knee replacement, will be recruited in accordance with the inclusion and exclusion criteria. Participants will be split into two groups – Group A (Post-Traumatic Osteoarthritis) and Group B (Primary Osteoarthritis). A structured data collection form will be used to capture demographic data and clinical variables. Functional outcomes will be evaluated by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) with its pain, stiffness and physical function sub scores and the Visual Analogue Scale (VAS) for pain. SPSS 27 will be used for data analysis. Independent t-test will be used to compare continuous variables and Chi-Square test will be used to compare categorical variables. Statistically significant differences will be indicated by a p-value <0.05.

Results: Primary OA patients are expected to show superior functional outcome after surgery than PT OA patients. PTOA patients can be expected to have somewhat poorer WOMAC pain, stiffness and functional scores, because of previous trauma sustained by the joint and increased surgical complexity. But there is likely to be a substantial functional improvement in both groups after total knee replacement.

Conclusion: KA is likely to result in substantial benefits in terms of reduction in pain and functional status in both post-traumatic and primary osteoarthritis patients. But functional recovery may be relatively poor in patients with post-traumatic osteoarthritis as compared to those with primary osteoarthritis. The results of this study will yield local data on postoperative functional results and could help orthopedic surgeons in their counseling and planning of surgical procedures as well as postoperative rehabilitation.