FUNCTIONAL OUTCOMES OF TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH ADVANCED OSTEOARTHRITIS: A RETROSPECTIVE COHORT STUDY
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Keywords
Total knee arthroplasty; osteoarthritis; KSS; WOMAC; functional outcome; varus deformity; Haryana; Mohri Shahbad
Abstract
Background: Total knee arthroplasty (TKA) is the definitive surgical treatment for advanced osteoarthritis refractory to conservative measures, with over 700,000 procedures performed annually in the United States and an escalating procedure volume in India driven by the country's rapidly ageing agricultural and industrial workforce. In Haryana, where Adesh Medical College & Hospital, Mohri Shahbad, serves a mixed urban-rural and agricultural population with high rates of heavy manual labour, obesity, and type 2 diabetes, the functional outcome determinants of TKA may differ materially from those characterised in high-income country series. Despite growing TKA volumes at regional tertiary hospitals in Haryana, institution-specific outcome data from this population remain unpublished.[1][2][18]
Objectives: To evaluate functional outcomes of TKA in patients with advanced osteoarthritis at Adesh Medical College & Hospital, Mohri Shahbad, across pre-operative, 3-month, 6-month, and 12-month timepoints, and to identify independent predictors of suboptimal functional outcome.
Methodology: A retrospective cohort study of 142 TKA procedures performed between May and December 2017 at the Department of Orthopaedics, Adesh Medical College. Outcomes assessed using Knee Society Score (KSS), WOMAC Index, Oxford Knee Score (OKS), VAS pain, range of motion, 6-Minute Walk Test, and Timed Up and Go test. Binary logistic regression identified independent predictors of fair/poor outcome. Analysis: SPSS v23.0 and Excel 2016.
Results: Mean KSS improved from 34.6+/-8.8 (pre-op) to 84.8+/-7.4 at 12 months (p<0.001). WOMAC decreased from 72.8+/-9.4 to 24.2+/-7.8 (p<0.001). Excellent/good outcomes were achieved in 96 patients (67.6%). Independent predictors of fair/poor outcome: varus >15 degrees (adj OR 3.42), BMI >=30 (OR 2.96), and uncontrolled diabetes (OR 3.28). Physiotherapy compliance >80% was independently protective (OR 0.32). Complication rate was 14.8%.
Conclusion: TKA delivers clinically and statistically significant functional improvement in advanced osteoarthritis at Adesh Medical College, Mohri Shahbad. Severe varus deformity, obesity, and uncontrolled diabetes are the dominant modifiable predictors of suboptimal outcome. Pre-operative deformity correction counselling, glycaemic optimisation, and structured physiotherapy compliance programmes represent priority interventions for the Haryana district orthopaedic programme.
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Dr. Nayak Maunilkumar Rajendrakumar
Assistant Professor, Department of Orthopaedics, Adesh Medical College & Hospital, Mohri, Shahbad, Haryana, India
