Article

OBJECTIVES: To determine the lifetime quality-adjusted life years (QALYs) gained
by total joint arthroplasty (TJA), and assess the QALYs attributed to specific
postoperative rehabilitation interventions. DESIGN: Secondary analysis of 2
multicenter, randomized controlled trials (RCTs)
with 3-, 6-, 12-, and 24-month
follow-up. SETTING: Two university hospitals, 2 municipal hospitals, and 1 rural
hospital. PARTICIPANTS: Patients (N=827) who underwent total hip arthroplasty
(THA) or total knee arthroplasty (TKA). INTERVENTIONS:
RCT A: 465 patients were
randomly assigned to receive aquatic therapy (pool exercises aimed at training of
proprioception, coordination, and strengthening) 6 versus 14 days after THA or
TKA. RCT B: 362 patients were randomly assigned to either perform or not perform
ergometer cycling beginning 2 weeks after THA or TKA. MAIN OUTCOME MEASURE:
QALYs, based on the Short Form-6 Dimensions utility, measured at baseline and 3,
6, 12, and 24 months' follow-up. RESULTS: After hip arthroplasty, the lifetime
QALYs increased by 2.35 years in the nonergometer group, and by 2.30 years in the
early aquatic therapy group. However, after knee arthroplasty, the lifetime QALYs
increased by 1.81 years in the nonergometer group, and by 1.60 years in the early
aquatic therapy group. By ergometer cycling, .55 additional QALYs could be gained
after hip and .10 additional QALYs after knee arthroplasty, while the additional
QALYs attributed to the timing of aquatic therapy were .12 years after hip and
.01 years after knee arthroplasty. CONCLUSIONS: This analysis provides a sound
estimate for the determination of the lifetime QALYs gained by THA and TKA. In
addition, this analysis demonstrates that specific postoperative rehabilitation
can result in an additional mean QALY gain of .55 years, which represents one
fourth of the effect of surgery. Even if this is interpreted as a small effect at
an individual level, it is important when extrapolated to all patients undergoing
TJA. At a national level, these improvements appear to have a similar magnitude
of QALY gain when compared with published data regarding medications to lower
blood pressure in all persons with arterial hypertension.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS