Identification of patients with suboptimal results after hip arthroplasty: development of a preliminary prediction algorithm

Abstract

BackgroundThe ability to predict preoperatively the identity of patients undergoing hip arthroplasty at risk of suboptimal outcomes could help implement interventions targeted at improving surgical results. The objective was to develop a preliminary prediction algorithm (PA) allowing the identification of patients at risk of unsatisfactory outcomes one to two years following hip arthroplasty.MethodsRetrospective data on a cohort of 265 patients having undergone primary unilateral hip replacement (188 total arthroplasties and 77 resurfacing arthroplasties) from 2004 to 2010 were collected from our arthroplasty database. Hip pain and function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected, as well as self-reported hip joint perception after surgery. Demographic and clinical variables recorded at the time of the surgery were considered as potential predictors. Patients were considered as having a suboptimal surgical outcome if they were in the worst quartile of the postoperative total WOMAC score and perceived their operated hip as artificial with minimal or major limitations. The PA was developed using recursive partitioning.ResultsMean postoperative surgical follow-up was 446 ± 171 days. Forty patients (15.1 %) had a postoperative total WOMAC score in the worst quartile (>11.5/100) and perceived their joint as artificial with minimal or major restrictions. A PA consisting of the following variables achieved the most acceptable level of prediction: gender, age at the time of surgery, body mass index (BMI), and three items of the preoperative WOMAC (degree of pain with walking on a flat surface and during the night as well as degree of difficulty with putting socks or stockings). The rule had a sensitivity of 75.0 % (95 % CI: 59.8-85.8), a specificity of 77.8 % (95 % CI: 71.9–82.7), a positive predictive value of 37.5 % (95 % CI: 27.7–48.5), a negative predictive value of 94.6 % (95 % CI: 90.3–97.0) and positive and negative likelihood ratios of 3.38 (95 % CI: 2.49–4.57) and 0.34 (95 % CI: 0.19–0.55) respectively.ConclusionsThe preliminary PA shows promising results at identifying patients at risk of significant functional limitations, increased pain and inadequate joint perception after hip arthroplasty. Clinical use should not be implemented before additional validation and refining.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0720-1) contains supplementary material, which is available to authorized users.

Implementing fast-track in total hip arthroplasty: rapid mobilization with low need for pain medication and low pain values

“…Wiesenfeld-Hallin postulates that the male sex is less sensitive to pain than the female [19]. Numerous studies described the evidence of a gender-related relationship with postoperative pain [20][21][22][23]. Other causes are given by psychological, biological and sociocultural factors.…”

Predictive Model and Web-based Calculator for the Oxford Hip Score After Total Hip Replacement

“…When predicting the Oxford Hip Score, the most relevant variables were: EQ-5D index, preoperative disability, preoperative problems with shopping, circulatory diseases, and pre-operative problems. Contrastingly, gender, age, BMI, pain, and problems with wearing stockings were the essential variables according to previous results [29]. Such differences might have resulted from our database having a greater degree of granularity related to specific activities of daily living, ultimately resulting in more distinct activities and scores.…”

“…Age and gender are established demographic predictors of outcomes following total hip replacement. These variables have been recently identified as important in the construction of algorithms to predict patients with poor outcomes following total hip replacement [29]. More specifically, the female gender and older age have been associated with lower improvement levels after total hip replacement alongside other clinical characteristics [30,31].…”

“…Other clinical symptoms have been reported to predict outcome following total hip replacement. For example, pain has been demonstrated in several studies to be an important predictor of poor outcomes following total hip replacement [29,30,32]. Similarly, co-morbidities such as osteoarthritis grade have been shown to determine outcomes following total hip replacement [30,32].…”

Improvement of Collagen Gel/Sponge Composite Scaffold by Gel Wrapping for Cartilage Tissue Engineering

“…Damaged cartilage cannot be recovered due to luck of circulation system. Until now, artificial joint replacement is the only effective treatment for the last stage of osteoarthritis [1]. However, recently, clinical applications of tissue engineered cartilage regeneration have been studied for the damaged cartilage.…”