gms | German Medical Science

Background, questions and purposes: Scarce literature is available on quality of life (QoL) after multiple joint replacements (MJR) of the lower limbs. Our objective was to describe the outcome, in terms of QoL as measured by the QWB-7, in patients who had bilateral knee and bilateral hip total joint replacements (TJR).

We therefore asked the following questions: (1) How much QoL do patients gain after their last surgery?; (2) If improved, is it sustained throughout time?; and (3) How does the normal QoL changes seen with age compares to that of our patients ?

Patients and Methods: Patients were identified making use of our joint registry database. We excluded patients with hemiathroplasties. A total of 11 patients who underwent bilateral knee and bilateral hip TJR (44 joints) were studied. Data was prospectively collected but retrospectively reviewed. Mean follow-up time after the 1st joint was replaced was 12 years. The outcome measure under investigation was the QWB-7 which was performed preoperatively and postoperatively at 3 months, 6 months, 1 year and annually thereafter.

Results: Initial diagnosis was RA in 7 patients (63.6%), primary osteoarthritis (OA) in 3 patients (27.3%) and ankylosing spondylitis in the remaining patient (9.1%). Revision rate was 13.63% (6 of 44 joints, four patients, four hips and two knees). All but one patient improved postoperatively (mean Delta 0.071) by the time of their last follow-up. QWB-7 scores seesawed throughout time. After all four surgeries were performed; maximum improvement in quality of life (mean Delta 0.184) was obtained at an average of 8 years after the first surgery.

Conclusions: Our data suggests that MJR of the lower limbs significantly improve quality of life after long term follow-up with the majority of patients enjoying a much better QoL. Even though QoL improvement varied among patients, for the vast majority of them, the improvement was clear and upheld throughout time even it was lower than the QoL of the normal population and of patients with maximal two replaced Joints.