The clinical benefits of total knee arthroplasty (TKA) are well
defined, but little attention has been paid to the cross-cultural
variation. The objective of this study was to compare case mix and
outcomes following TKA in Swiss and Scottish patients.
Data from local registries at a Swiss and a Scottish orthopaedic
hospital were extracted to evaluate: (A) age, sex, body mass index
(BMI), self-reported health status (EQ-5D), and joint awareness
(Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement
in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C)
patient satisfaction at 1 year.
Data from 2075 Swiss and 994 Scottish TKA patients were available
from the local registries. Swiss and Scottish patients differed in
age (69.3 vs 68.8 years, p = 0.046), sex ratio
(62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs
30.9, p < 0.001). At pre-surgery, FJS-12 scores
were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D
scores were better in Swiss patients (0.52 vs 0.40,
p < 0.001). Post-operative improvement was greater
in Switzerland for the FJS-12 (+ 55.1 vs + 32.2,
p < 0.001), but not for the EQ-5D (+ 0.31 vs
+ 0.29, n.s.). The satisfaction rate was similar in both
groups (88.3% vs 89.6%, n.s.).
LEVEL OF EVIDENCE
Subtle cross-cultural variation was evident in TKA case-mix factors
between the two countries. Satisfaction and improvement in health
status were similar, while improvement in joint-specific outcome was
notably greater in Switzerland. Understanding cross-cultural
variability of the outcome has important implications when
interpreting study and registry data from other countries and when
counselling a patient in daily practice.
Retrospective cohort, Level III.