Functioning Before and After Total Hip or Knee Arthroplasty

Osteoarthritis (OA) of the hip or knee is a common locomotor disease characterized by degradation of articular cartilage. In the Netherlands, in the year 2000 about 257,400 persons above the age of 55 years had hip OA and about 335,700 persons had knee OA. Because the prevalence of OA will increase with the aging of the Western population, the percentage of persons with OA is expected to increase by about 38% from the year 2000 to 20201. OA not only causes pain and loss of joint mobility, but also leads to restriction of physical functioning: patients can no longer walk as far or as fast as they could before, they have diffi culties with climbing stairs, standing up from a sitting position, dressing themselves, etc. Initial treatment aims to suppress the symptoms and to improve or maintain functioning by means of self-administered pain medication, or focuses on advice about avoiding overuse of the joint, on injections with corticosteroids into the joint, and on physical therapy. In advanced stage OA, when these options no longer provide suffi cient pain relief or solve functional problems, a total hip or knee arthroplasty is the most common alternative. In total hip arthroplasty (THA) or total knee arthroplasty (TKA) the joint surface is replaced with an artifi cial device (prosthesis). In the Netherlands, the numbers of primary THAs have increased from 6,571 procedures in 1980 to 18,186 procedures in 2000, which is an increase of 270%. From 1996 to 2005, the numbers of TKAs increased by 255%, from 4,046 to 10,3295. Moreover, the annual number of both THAs and TKAs is expected to increase in the coming decades. The majority of patients undergoing a total hip or knee arthroplasty do experience a reduction of pain and improvement of quality of life.