Evaluation of the impact of primary knee osteoarthritis on patient’s quality of life at Muhimbili Orthopedic Institute 2019/2020, Dar Es Salaam

Abstract

ABSTRACT Background: Primary knee osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem. (1)(2)(3) It is commonly seen in elderly women over 50 years of age. It is also reported to have a significant impact on physical functionality, role emotion, and social functioning, leading to poor quality of life. (4)(5)(6)

The main objective: To evaluate the impact of primary knee OA on quality of life among patients attending orthopedic clinics at Muhimbili Orthopedic Institute 2019/2020.

Patients and Methods: This was an observational cross-sectional study, conducted at Muhimbili Orthopedic Institute. A total of 163 patients were recruited into the study. After clinical and radiological evidence of primary knee osteoarthritis; clinical history, physical examination, and radiological findings were recorded according to Kellgrene &Lawrence (K-L), pain severity was evaluated by Visual Analogue Scale (VAS). Quality of life (QoL) was assessed using the English/Swahili Short Form (SF)-36 questionnaire. Data analysis was carried out using SPSS Version 24.0. Student t-test was used for comparison of means and an alpha of 0.05 adopted for statistical significance.

Results; A total of 163 participants were enrolled. The mean age of the study population was 63.7±9.2 years, and majority were female (74.8%). Fifty percent of patients enrolled had at least primary education, 39.3% were self-employed, and 22.1% were retirees. Based on geographical location of the OA participants, 51.5% were from Coastal Zone (Dar es salaam, Lindi, Morogoro, Mtwara and Pwani), 16.6% from Zanzibar (Unguja and Pemba), 9.8% from lake zone (Geita, Kagera, Mara, Mwanza, Shinyanga and Simiyu), 9.2% from Southern Highland zone(Iringa, Mbeya, Njombe, Rukwa, Ruvuma, and Songwe), 7.4% northern zone (Arusha, Kilimanjaro, Manyara, and Tanga), 1.2% were from central zone(Dodoma, Singida and Tabora), and 4.3% were from the Western Zone, (Kigoma and Katavi). Half of the patients (50%) were hypertensive and 12.9% were diabetic. Clinically, 89.0% presented with bilateral knee OA, 52.8% experienced knee pain for >6years, and 67.5% reported very severe knee joints pain. However, knee stiffness, mechanical instability, and catching sensation were the common OA features experienced by 95% of the participants, 76.7% had K-L grade 4 and 51.5% had BMI 25-29.9. On assessment of health related quality of life, across all 8 domains of SF-36, vitality, mental health, and role emotion had higher mean scores above 50%. On the other hand, general health, physical role, bodily pain, social functioning, and physical functioning domain had the lowest mean score <50% with statistical significance p<0.05 at a longer duration of illness >6 years.

Conclusion: Primary knee osteoarthritis was commonly seen among elderly women, with the mean age 63.5 +/- 9.2 years. Severe knee pain, stiffness, mechanical instability, mechanical locking, catching sensation, reduced joint space and joint deformity were the most experienced clinical features. The primary knee OA has a great impact on the quality of life among patients attending orthopedic clinics at MOI. The greatest impact was seen on physical and social functioning, with less effect on mental health. Patients with primary knee osteoarthritis attending to orthopedic clinics, therefore, have a poor health-related quality of life.