Specific knowledge and resilience affect short-term outcome in patients following primary total hip arthroplasty

Alexander Bumberger,Wenzel Waldstein,Madeleine Willegger,Gerhard M Hobusch,Stephan Domayer,Katharina Borst,Reinhard Windhager

doi:10.1007/s00402-021-03967-0

Abstract

PurposeThe aim of the present study was to investigate the potential associations between specific knowledge, resilience and patient-reported outcome measures (PROMS) following primary total hip arthroplasty (THA).MethodsIn a cross-sectional prospective study, consecutive patients following primary THA were included at a rehabilitation center. A novel knowledge score and the validated Connor Davidson Resilience Scale (CD-RISC) were utilized to assess patients’ specific knowledge and resilience, respectively. Additionally, patients completed a qualitative questionnaire regarding the information they had received. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as the University of California and Los Angeles Score (UCLA) served as primary outcome measures. Stepwise multiple regression analysis was performed to identify potential predictors of outcome.ResultsA total of 103 patients at a mean age of 67.5 years (SD 10.5, 38–88) were included in the analysis at a median of 55.5 days (IQR 43–81) following primary THA. The mean knowledge and resilience scores were 3.8 (SD 1.6, 0–7) and 69.5 (SD 18.5, 0–100), respectively. Forty-seven percent of patients were afraid of harming their prosthesis and these patients had up to 59% worse WOMAC scores (p < 0.001). WOMAC scores on admission to rehabilitation were predicted by resilience and knowledge scores (R2 = 0.106, p = 0.036). UCLA scores at the time of admission were predicted by knowledge scores (R2 = 0.078, p = 0.007).ConclusionThe present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary THA. Moreover, it could be shown that higher specific knowledge and resilience are associated with a better functional outcome according to validated PROMS. While these findings need to be prospectively validated in future studies, specific patient knowledge and resilience may have a direct impact on the outcome of primary THA.

Highlights

Osteoarthritis (OA) of the hip and knee poses a major health burden and is ranked among the top contributors to global disability [1]
Students’ t-test for independent samples demonstrated that patients with a feeling of uncertainty had up to 59% worse WOMAC scores (p < 0.001) and up to 15% worse University of California and Los Angeles Score (UCLA) scores (p = 0.016) as compared to patients without (Table 2)
The present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary total hip arthroplasty (THA)

Summary

Introduction

Osteoarthritis (OA) of the hip and knee poses a major health burden and is ranked among the top contributors to global disability [1]. One aspect includes patients’ specific knowledge which was shown to be low in an arthroplasty population [5]. In this context, an interdisciplinary patient education program in total joint arthroplasty (TJA) was demonstrated to effectively decrease postoperative complications and the number of patients being discharged to post-acute care facilities [6]. A one-on-one patient education session before THA or total knee arthroplasty (TKA) seems to significantly reduce length of hospital stay as compared to controls [7]. An observational study evaluating patients from the Swedish hip arthroplasty register showed only minor effects of preoperative patient education on functional outcomes as assessed by patient-reported outcome measures (PROMS) [8]. As there is some considerable methodological heterogeneity of reported studies, the definite significance of patients’ individual knowledge about the procedure remains unknown and might be of underestimated relevance in TJA

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