Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.

Luigi F. Rodella,Vikki Wylde,Rachael Gooberman-Hill,Erik Lenguerrand,Michael R. Whitehouse,Ashley W. Blom

doi:10.1371/journal.pone.0164839

Luigi F. Rodella, Vikki Wylde + Show 4 more

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https://doi.org/10.1371/journal.pone.0164839

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Journal: PloS one	Publication Date: Oct 14, 2016
Citations: 21	License type: CC BY 4.0

Affiliation: Southmead Hospital, University of Bristol

Abstract

Background and PurposePatients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty.MethodsThis study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis) and revision (n = 43) hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0–3 months and 3–12 months) between types of surgery.ResultsThe improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty.ConclusionThe post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be improved with specific post-operative interventions.

Highlights

The volume of primary hip arthroplasties rose by approximately 26% between 2010 and 2015 [1, 2]
We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty
While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty

Summary

Introduction

The volume of primary hip arthroplasties rose by approximately 26% between 2010 and 2015 [1, 2]. Over 88,000 primary total hip arthroplasties are performed per year in England and Wales [2]. These figures will continue to rise due to increases in obesity and an aging community [3]. The revision burden is approximately 11% and over 9,500 revision hip arthroplasties were performed in England and Wales in 2015 [1, 2] Both primary and revision hip arthroplasty have been shown to improve patient-reported pain and function for the majority of patients [4,5,6,7,8]. While patients tend to have similar [5, 6, 8] or better [7] pain and function prior to revision arthroplasty than prior to primary arthroplasty, patients who undergo primary surgery report better post-operative outcomes than those who undergo revision surgery [5,6,7]

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Conclusion