Abstract
Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.
Highlights
Licensee MDPI, Basel, Switzerland.Total hip arthroplasty combined with the concept of enhanced recovery is of worldwide interest and in intense discussion in the recent literature [1,2,3,4,5,6]
It could be shown that an enhanced recovery concept after total hip arthroplasty (THA) reduced the length of hospital stay with no significant increase in the incidence of complications and readmission [8,9,10,11]
Patients participating in an enhanced recovery concept showed a high patient satisfaction after total cementless hip arthroplasty
Summary
Total hip arthroplasty combined with the concept of enhanced recovery is of worldwide interest and in intense discussion in the recent literature [1,2,3,4,5,6]. Besides alteration of medical treatment details, the concept includes optimizing logistical and organizational aspects, implementing a multimodal opioid-sparing pain therapy and a structured management. To accelerate the recovery process in general, Kehlet et al used evidenced-based medical interventions to minimize surgical stress, to reduce physical and psychological. It could be shown that an enhanced recovery concept after THA reduced the length of hospital stay with no significant increase in the incidence of complications and readmission [8,9,10,11]. Enhanced recovery after total hip arthroplasty (THA)
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