Social and Personal Consequences of Disability in Adults with Hip and Knee Arthroplasty. A French National Community Based Survey

ISABELLE BOUTRON, SERGE POIRAUDEAU, PHILIPPE RAVAUD, GABRIEL BARON, MICHEL REVEL, REMY NIZARD, MAXIME DOUGADOS, and JEAN-FRANÇOIS RAVAUD

ABSTRACT.

Objective. To describe and compare participation restrictions and environmental factors of persons with and without hip or knee arthroplasty in a national community based survey: the Handicap, Disability, Dependence Survey.

Methods. During the 1999 French Census, a screening questionnaire was proposed to 417,500 persons, for which the response rate was 86%. A stratified random sample with an overrepresentation of disabled persons was performed to constitute the selected population. A computer assisted interview was proposed to 21,760 persons, with a 78% response rate. Chronic conditions, impairment, disability, participation restrictions, and the description of environmental factors were ascertained from the subjects' reports.

Results. The hip and knee arthroplasty group was estimated at 691,000 persons in the French population. Although reporting a higher level of disability, this population did not report more participation restrictions than the general population in terms of their economic situation, housing, social relationships, and holidays. Moreover, when comparing environmental factors, this population reported better housing accessibility, more assistive devices (OR 5.2, 95% CI 3.7–7.2), specific fittings (OR 2.9, 95% CI 2.0–4.2), and helpers (OR 1.8, 95% CI 1.3–2.5). These environmental factors may have compensated for the higher level of disability. Nevertheless, individuals with hip and knee arthroplasty reported more disadvantages when moving within their environment (OR 2.1, 95% CI 1.5–2.9).

Conclusion. This study provides a detailed description based on a national random sample of participation restrictions and environmental factors of adults with hip and knee arthroplasty. (J Rheumatol 2004:31:759-66)

Key Indexing Terms:

EPIDEMIOLOGY
DISABILITY
PARTICIPATION RESTRICTION
ARTHROPLASTY
HIP
KNEE

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From the National Institute of Statistics and Economic Studies (INSEE), Paris; Réseau Fédératif de Recherche sur le Handicap, Vincennes; and Centre d'Enseignement et de Recherche en Mécanique des Sols (CERMES), INSERM U502, Villejuif, France.

Supported by the Ministry of Employment and Solidarity, National Social Security, by mutual insurance organizations, insurance companies, and disability associations.

I. Boutron, MD; S. Poiraudeau, MD, PhD, Département de Médecine Physique et de Réadaptation, Hôpital Cochin (AP-HP), Paris, Réseau Fédératif de Recherche sur le Handicap, Paris; P. Ravaud, MD, PhD; G. Baron, BSc, Département d'Epidémiologie, Biostatistique et de Recherche Clinique, Groupe hospitalier Bichat-Claude Bernard (AP-HP), Université X. Bichat, Paris; M. Revel, MD, Département de Médecine Physique et de Réadaptation, Hôpital Cochin, Réseau Fédératif de Recherche sur le Handicap; R. Nizard, MD, PhD, Service d'Orthopédie, Hôpital Lariboisière (AP-HP), Université D. Diderot, Paris; M. Dougados, MD, Service de Rhumatologie, Hôpital Cochin, Université R. Descartes, Paris; J-F. Ravaud MD, PhD, CERMES, INSERM U502, Villejuif, Réseau Fédératif de Recherche sur le Handicap.

Address reprint requests to Dr. S. Poiraudeau, Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, Hôpital Cochin, 27 rue du Faubourg St. Jacques, 75679, Paris cedex 14, France. E-mail: serge.poiraudeau@cch.ap-hop-paris.fr

Submitted October 23, 2002; revision accepted August 19, 2003.

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