Quality of life outcomes following knee arthrodesis in a resource poor setting

Background: For cases of chronic, intractable, knee pain in a resource poor setting such as Cambodia, knee arthrodesis may be an acceptable solution, offering pain relief, useful function and preservation of the limb.

Objectives: We studied the post-operative health related quality of life of patients following knee arthodesis in a resource poor setting.

Methods: The Children’s Surgical Centre, (CSC), providing free operations to disabled people, in Phnom Penh, Cambodia, performed 13 knee arthrodesis procedures in the period between January 2007 and February 2012. We were able to follow up 8 of these patients and used the Health Survey Short Form 36 version 2 (SF-36v2) (Quality Metric Incorporated and Medical Outcomes Trust) survey, to assess the impact of the procedure on their quality of life. We also asked patients whether they had been employed before and after undergoing knee arthrodesis.

Results: On SF-36v2, the post-op mean physical component score (PCS) was just below average at 47.6, indicating they had almost normal function and the mean mental component score (MCS) was low at 39.9, meaning their mental health was below normal (the average is 50 in a normal population). Five out of seven patients were continuing to work after undergoing arthrodesis, four of them in physically demanding occupations.

Conclusion: The results show that in this resource poor setting, knee arthrodesis gives good results. According to the SF-36v2, the mean post-operative bodily pain score was above average, indicating freedom from normal pain. (Knee pain is the primary indication for arthrodesis at CSC). Arthrodesis allows the maintenance of physical function at a level enabling patients to work in practical occupations such as farming. This study highlights some of the issues surrounding knee arthrodesis which should be explored further, such as possible effects on mental health and social functioning.