Psychological, Sexually and Social Consequences of Osteoarthritis Treatment With THA or TKA and Joint Preserving Surgery
Psychological, Sexually and Social Consequences of Osteoarthritis Treatment With THA or TKA and Joint Preserving Surgery
The project runs as a Ph.d. project at the Faculty of Health Sciences- University of
 Copenhagen.

 In Denmark the investigators operate around 16.000 artificial hips and knees yearly, mainly
 due to osteoarthritis. The numbers has increased with 13,9% for hips and 50,7% for knees in
 the period 2004 to 2007. In 10% of the cases, or approximately 1.600 patients, the patient is
 younger than 50 years - mid-life, working, socially active and sexually active. The
 investigators have a tendency within in the orthopedic society to mainly focus on the
 technological aspects of the procedure and tend to forget that this is a key event for the
 patient with widespread consequences for the patient and his future life.

 Hip- and knee arthroplasties is without no doubt two of the most important and successfully
 surgical procedures ever introduced. The economical cost for osteoarthritis treatment has
 exploded in the developed world over the last decade, with a yearly growth on 8%.

 Because of the limited lifetime for an artificial hip or knee, this treatment can be
 unfortunate for the young patient. This has over the last years led to an increased interest
 for joint preserving surgery. Over the last twenty years it has been tried to delay the time
 for total hip arthroplasties for patients with hip dysplasia with the aid of Ganz osteotomy.
 Since this technique was introduced back in 1988, the research on the topic has had its main
 focus on optimizing the operation technique. So as with surgery with artificial hip or knee
 the investigators have a lack of knowledge regarding the social, work related, psychological
 and sexual aspects of this treatment.

 Purpose The consequences of an artificial hip or knee joint regarding patients' social-life,
 work, psychological and sexual aspects gain very little attention international. The
 investigators apply most of our research funds exclusively to research and development of the
 surgical track and procedure, new prosthesis designs or coatings. The investigators find this
 study highly relevant because this kind of studies has been preformed for several chronic
 diseases but not osteoarthritis and its treatment.

 With this study the investigators wish to examine the social, work related, psychological and
 sexual aspects of end stage osteoarthritis. This will lead the way for improved information
 to the patient and improve the surgeons' possibilities for chosen the correct time for
 surgery.
In Denmark approximately 16.000 artificial hips or knees are inserted yearly. A increasing
 number that probably will continue to increase due to demographic factors and the populations
 rising demands on a active life in the old age. However of the 16.000 artificial joints
 approximately 10% are inserted in patients under fifty years(1;2). This group of patients is
 mid-life and thereby for most parts working and socially- and sexually active.

 Total hip arthroplasty(THA) or total knee arthroplasty(TKA) is unquestionably one of the most
 successfully operations there has been introduced, and is capable of relieving pain,
 optimizing the function of the joint and optimizing the quality of life(3;4). In the resent
 years the main focus has been on optimizing the surgical track, whereby most of the patient
 today are only admitted to the hospital in 1-2 days. This progress has had a tremendous
 impact on patients, the departments and the health care system. Joint replacement surgery
 with THA or TKA is a key event for the patient and can recreate the patient's mobility but as
 well has widespread (but still undocumented) consequences for the patient and his future
 life.

 In the preoperative treatment and planning of the correct time of surgery, it is imported to
 know, how the patient is affected of a disabling joint disease like end-stage
 osteoarthritis(OA) and which consequences it has to the patient to have an artificial joint.
 It is known, that patients with OA has a two-fold increased risk of depression(8-13).

 These aspects of the treatment has so far not had the desirable attention, neither national
 or international At Hvidovre Hospital, Frederiksberg Hospital and Køge Hospital the
 Orthopaedic departments has many years of experience with joint replacement surgery at
 specialist level. The structures of the departments are based on modern fast-track
 principals, with clearly defined goals for preoperative information, pre- and postoperative
 regimes and discharged criteria. Thereby insuring a smooth course, short rekonvalens and a
 minimizing of complications.

 Because of the limited lifetime for an artificial hip or knee, this treatment can be
 unfortunate for the young patient. This has over the last years led to an increased interest
 for joint preserving surgery. Over the last twenty years it has been tried to delay the time
 for total hip arthroplasties for patients with hip dysplasia with the aid of Peri Acetabular
 Osteotomy(PAO). Hip dysplasia is seen equally in both sexes. However it is more often
 symptomatic in females(14). In Denmark PAO is performed at Copenhagen University Hospital,
 Odense University Hospital and Aarhus University Hospital. The procedure is preformed on
 symptomatic (mainly sharp groin pain) patients in hope of delaying the development of OA.
 Femoroacetabular impingement (FAI) is believed to be the pathology, where repeated trauma to
 the acetabular labrum and adjacent chondral structures can result in labral tears and
 chondral delamination, leading to groin pain and over time OA. However there are only a few
 minor studies concerning which impact this procedure has on the young patients life in term
 of psychological, sexually and social wellbeing.

 Patients included are both men and women from twenty to sixty years old who are admitted to
 undergo primary uni- or bilateral THA or TKA at Hvidovre Hospital, Frederiksberg Hospital or
 Køge Hospital as a result of end-stage OA, rheumatoid arthritis or another joint disease
 diagnosed by one of the departments doctors with specialty in joint replacement surgery. The
 included patients in the PAO study has all had PAO at Aarhus University Hospital between
 1999-2002 and were at the age of fifteen or more at the time of surgery. To avoid
 co-morbidity confounders the joint disease has to be the only main disease.

 The goal of the study is to investigate:

 1. What are the Health-Related-Quality-Of-Life(HRQoL) consequences of end-stage hip or knee
 OA? The investigators will examine this with SF-36, a standardized and validated
 questionnaire that explores HRQOL.

 2. What is the relation between the pre- and postoperative joint function and the patients
 HRQoL, and do this relation reflects the patient's social class and attachment to the
 workforce.

 3. Which preoperative parameters have the strongest relation on the postoperative out-come?
 The highly nuanced picture the investigators get of the patients pre- and postoperative
 condition will enable us to answer this question.

 4. How is the patient's relation to the workforce-affected by the patient's joint disease
 and operation? Are the investigators able to operate the patient back in work? Do the
 patient lose he's job because of the operation? Do the patient's with a job preoperative
 keep their job will those without a job preoperative do not recover their working
 ability because of the operation?

 5. It is known that patients with OA has a two fold increased risk of depression. Is the
 depression due to the patients underlying disease? Or is the depression due to
 modulations in pain perception which lead to a lower pain threshold that again leads to
 the increased prevalence of symptomatic OA? If the THA or TKA is curative for the
 patient's depression, the investigators may assume that the depression is due to the
 patients disabling disease and vice versa.

 6. It is known that patients with hip OA experience sexual-problems. How is this affected
 by joint replacement surgery? A Danish study has shown that older men -average age 70
 years- who receives a THA has a highly increased risk of postoperative impotence -26%
 compared to the expected 3% for an age matched group. Other studies have shown that
 females experience an improvement of there sexual-life after THA. Unfortunately, there
 are only quite few and small studies concerning these subjects. The investigators wish
 to explore these subjects and the similar subjects for TKA, this has not previously been
 explored.

 7. Over the last three decades there has been an increasing focus on joint preserving
 surgery, mainly in the form of PAO. This procedure is preformed on public hospitals in
 Aarhus University Hospital, Odense University Hospital and Copenhagen University
 Hospital. Aarhus University Hospital holds the leading experience in Denmark and
 performs approximately 75 procedures a year. However there is now documentation on how
 this procedure affects the patients HRQoL or sexual-life.

 The main part of this study runs as a prospective questionnaire based study of the patients,
 which are having a THA or TKA at Hvidovre University Hospital, Frederiksberg University
 Hospital and Køge Hospital. A smaller part of the study is a retrospective questionnaire
 based study of the patients, which in the period 1999-2002 underwent PAO at Aarhus University
 Prior to planned surgery with THA or TKA the patient receive a questionnaire. This will be
 followed by a questionnaire 3, 6 and 12 months postoperative. Twelve months postoperative the
 patient will have and ambulatory control.

 The patients who underwent PAO at Aarhus University Hospital in the period 1999-2002 are
 posted a questionnaire.

 The inclusions of patients started April 2010 and runs at least to the summer of 2011 or when
 at least 250 patients are included.

 The results are expected to be published in international English language journals and the
 research and findings will be defended as a PhD ad the Faculty of Health Sciences- University
 of Copenhagen.

 Purposes of the study:

 Primary purpose:

 To investigate how end-stage OA and joint replacement surgery affects the patients HRQoL and
 herby which impact this procedure has on the young patients life in term of psychological,
 sexually and social wellbeing. Next the investigators wish to investigate how the patients'
 attachment to the workforce is affected bye end-stage OA and joint replacement surgery

 Secondary purpose:

 To investigate how patients with other disabling joint diseases with need for joint
 replacement surgery is affected as described above.

 Tertiary purpose:

 Edification of a database to reveal complications over years for this well-defined young
 patient population, who has a higher demand to there prosthesis and as a consequence put them
 to a higher stress.

 Other purposes:

 To investigate which impact PAO has on the young patients life in term of HRQoL,
 psychological, sexually and social wellbeing.
Inclusion Criteria:

 -  Patients born from 01.01.1950, who are submitted fore primary THA or TKA on Hvidovre
 University Hospital, Frederiksberg University Hospital or Køge Hospital.

 -  The patient has to be capable of understanding Danish

 -  The patient has to be mental well an capable of understanding the information

 -  The patient must not have other major diseases

 Exclusion Criteria:

 -  Terminal diseases

 -  Lack of ability to follow the department's standard procedures