Short-term patient-reported outcomes following total hip replacement: Is the success picture overrated?

Marek Kamil Gojło,Robert Lundqvist,Przemysław T Paradowski

doi:10.1016/j.ocarto.2021.100192

Abstract

ObjectivesOur objective was report short-term results of total hip replacement (THR) and to identify patients with functional recovery and with treatment failure. We also aimed to investigate whether there are any potential predicting factors for functional recovery or treatment failure. DesignProspective cohort study. Clinical examination was performed and data were collected from patients before THR and at three follow-up assessments within subsequent year. The primary endpoint was the change between assessments in the average score on four subscales of the Hip disability and Osteoarthritis Outcome Score (HOOS4) covering pain, symptoms, activity of daily living, and quality of life. Secondary endpoints included results on all five HOOS subscales, and the SF–36. Functional Recovery and Treatment Failure were defined basing on the published reference population values. ResultsWe assessed 179 patients (98 women and 81 men, mean age at THR 67 years, range 31–90 years). The mean HOOS4 scores continued to improve up to 12 months after THR. Functional Recovery was identified in 32% while Treatment Failure in 16% of the patients. We found an association between high (>30.3) preoperative SF–36 Physical Component Summary scores and Functional Recovery, as well as low preoperative SF–36 Physical (<30.3) and Mental (<35.9) Component Summary scores and Treatment Failure. ConclusionsKnowing that only one third of subjects undergoing THR achieved Functional Recovery and one sixths had Treatment Failure, gives us a better perspective to discuss feasibility of expectations and, consequently, to prevent patient dissatisfaction following THR.

Highlights

Total hip replacement (THR) is one of the most common and most successful surgical operations in medicine [1]
We found that patients after THR improved in both HOOS4 and in separate Hip disability and Osteoarthritis Outcome Score (HOOS) subscales
The mean difference between the baseline results and the HOOS scores one year after THR is nearly 50 points in the HOOS4, and even more than 50 points in two HOOS subscales: Symptoms and activities of daily living (ADL). This remarkable improvement was higher than reported in other studies [ [38,39]]

Summary

Introduction

Total hip replacement (THR) is one of the most common and most successful surgical operations in medicine [1]. The implant survival index, says nothing about postoperative patient satisfaction, pain reduction, hip function or quality of life. It has been estimated that between 6 and 15% of patients undergoing THR have persistent pain and functional limitation [6] and 6–7% are not satisfied with the result of the operation after one year [ [7,8]]. Most of the studies involving THR patients THR, even those based on registers, report patients' outcomes in a longer time perspective [12]. It has been found, that most of clinically relevant improvement following primary joint replacement occurs within the first six months

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