Do changes in outcomes following primary and revision hip replacement differ and relate to markers of socioeconomic status? A 1-year population-based cohort study

Abstract

Background and purpose: There is little evidence on improvement after revision total hip replacement (THR). Moreover, improvements may be associated with socioeconomic status (SES). We investigated whether changes in Harris Hip Score (HHS) differ among patients undergoing primary and revision THR, and their association with markers of SES. Patients and methods: We conducted a populationbased cohort study on 16,932 patients undergoing primary and/or revision THR from 1995 to 2018 due to hip osteoarthritis. The patients were identified in the Danish Hip Arthroplasty Registry. Outcome was defined as mean change in HHS (0–100) from baseline to 1-year follow-up, and its association with SES markers (education, cohabiting, andwealth) was analyzed using multiple linear regression adjusting for sex, age, comorbidities, and baseline HHS. Results: At 1-year follow-up, HHS improved clinically relevant for patients undergoing both primary THR: mean 43 (95% CI 43–43) and revision THR: mean 31 (CI 29–33); however, the increase was 12 points (CI 10–14) higher for primary THR. For primary THR, improvements were 0.9 points (CI 0.4–1.5) higher for patients with high educational level compared with low educational level, 0.4 points (CI 0.0–0.8) higher for patients cohabiting compared with living alone, and 2.6 points higher (CI 2.1–3.0) for patients with high wealth compared with low wealth. Interpretation: Patients undergoing primary THR achieve higher improvements on HHS than patients undergoing revision THR, and the improvements are negatively related to markers of low SES. Health professionals should be aware of these characteristics and be able to identify patients who may benefit from extra rehabilitation to improve outcomes after THR to ensure equality in health.

What’s New in Hip Replacement

“…In a recent study examining the effects of socioeconomic status on Harris hip scores at 1 year after primary and revision THAs, Stisen et al observed improvement in patient-reported outcome scores at the 1-year follow-up 6 . Using a database of 16,932 patients undergoing a surgical procedure between 1995 and 2018, the authors found that scores were 2.6 points (95% CI, 2.1 to 3 points) higher for primary THA for patients with high wealth compared with those with low wealth and 12 points (95% CI, 10 to 14 points) higher for patients with high education compared with those with low education.…”

Effect of an exercise intervention targeting hip strengthening in patients undergoing revision total hip replacement—A study protocol for a multicenter randomized controlled trial

“…Revision THR is a technically more challenging procedure than primary THR; however, patients undergoing revision THR report improvements in pain and function (Saleh et al., 2003). Nevertheless, a registry‐based analysis demonstrated poorer clinical outcomes on hip pain and function for patients after revision THR than following primary THR (Stisen et al., 2022). Evidence on revision THR in terms of the effectiveness of pain relief and functional improvement is sparse (Singh & Lewallen, 2013), and no consensus exists on optimal rehabilitation after revision THR (Newman & Barker, 2017).…”