Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty

BackgroundThe aim of the study was to analyze the effect of preoperative patient characteristics on health outcomes 6 months after total hip replacement (THR), to support patient’s decision making in daily practice with predicted health states and satisfaction thresholds. By giving incremental effects for different patient subgroups, we support comparative effectiveness research (CER) on osteoarthritis interventions.MethodsIn 2012, 321 patients participated in health state evaluation before and 6 months after THR. Health-related quality of life (HRQoL) was measured with the EQ-5D questionnaire. Hip-specific pain, function, and mobility were measured with the WOMAC in a prospective observation of a cohort. The predictive capability of preoperative patient characteristics – classified according to socio-demographic factors, medical factors, and health state variables – for changes in health outcomes is tested by correlation analysis and multivariate linear regressions. Related satisfaction thresholds were calculated with the patient acceptable symptom state (PASS) concept.ResultsThe mean WOMAC and EQ-5D scores before operation were 52 and 60 respectively (0 worst, 100 best). At the 6-month follow-up, scores improved by 35 and 19 units. On average, patients reported satisfaction with the operation if postoperative (change) WOMAC scores were higher than 85 (32) and postoperative (change) EQ-5D scores were higher than 79 (14).ConclusionsChanges in WOMAC and EQ-5D scores can mainly be explained by preoperative scores. The lower the preoperative WOMAC or EQ-5D scores, the higher the change in the scores. Very good or very poor preoperative scores lower the probability of patient satisfaction with THR. Shared decision making using a personalized risk assessment approach provides predicted health states and satisfaction thresholds.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0108-1) contains supplementary material, which is available to authorized users.

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“…Related studies are by trend conform to our study [3,7,31-33]. THR outcome was mainly related to preoperative WOMAC and EQ-5D scores.…”

Section: Discussionsupporting

confidence: 89%

The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study

Vogl

Wilkesmann

Lausmann

et al. 2014

Health Qual Life Outcomes

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“…However, the areas of pain relief and physical function revealed relatively poorer improvement than other functions. This might implicate there was a trend for patients who had had more severe functional problems before the surgery to have poorer pain and physical functions after revision THA [15]. Nevertheless, the items for the role subscales have 5 possible answer levels in version 2 of the SF-36 instead of 2 (present/absent) in version 1.…”

Section: Discussionmentioning

confidence: 99%

Responsiveness and minimal important differences after revision total hip arthroplasty

Shi

Chang

Wong

et al. 2010

BMC Musculoskelet Disord

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BackgroundThe health-related quality of life (HRQoL) is currently weighted more heavily when evaluating health status, particularly regarding medical treatments and interventions. However, it is rarely used by physicians to compare responsiveness. Additionally, responsiveness estimates derived by the Harris Hip Score (HHS) and the Short Form 36 (SF-36) before and after revision total hip arthroplasty (THA) have not been clinically compared. This study compared responsiveness and minimal important differences (MID) between HHS and SF-36.MethodsAll revision THA patients completed the disease-specific HHS and the generic SF-36 before and 6 months after surgery. Scores using these instruments were interpreted by generalized estimating equation (GEE) before and after revision THA. The bootstrap estimation and modified Jacknife test were used to derive 95% confidence intervals for differences in the responsiveness estimates.ResultsComparisons of effect size (ES), standardized response means (SRM), relative efficiency (RE) (>1) and MID indicated that the responsiveness of HHS was superior to that of SF-36. The ES and SRM for pain and physical functions in the HHS were significantly larger than those of the SF-36 (p < 0.001).ConclusionThe data in this study indicated that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.

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“…Yet, our knowledge and understanding of the factors that impact inpatient rehabilitation length of stay (LOS) after revision hip replacements are limited. Most studies on revision hip replacement were not in the area of LOS, but related to risk factors and indications for surgery or implant survival/surgical procedures,[13-18] function [7,12,19-21] or health related quality of life [22]. Studies on LOS on patients with revision surgery mostly focused on costs in the acute care settings [8,10,23], while a small number of studies evaluating factors that impact rehabilitation LOS for people with revision versus primary THR gave conflicting information.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study

Yeung

Davis

Soric

2010

BMC Musculoskelet Disord

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BackgroundThe annual incidence of revision hip replacements has increased in both Canada and United States, particularly in younger adults. Patients following revision hip replacements often require longer hospital length of stay (LOS) but little is known about predictors of inpatient rehabilitation LOS in this group of patients. The purpose of this study was to evaluate the socio-demographic, pre-surgery, surgery and post-surgery related factors that might influence rehabilitation LOS of inpatients following revision hip replacements.MethodsThis study included inpatients discharged from a musculoskeletal ward between 2002 and 2006 following rehabilitation revision hip replacement. Data sources included the National Reporting System, a standardized, provincial administrative database and augmented by chart abstraction. The collected elements included the outcome LOS and the following independent variables: age, sex, support at home, environmental barriers, language barrier, number of revision surgeries on the affected hip, comorbidity, previous orthopaedic surgeries in the lower extremities (L/ES), the hip component(s) revised, weight-bearing status, hemoglobin level, complications, days lapsed from surgery to rehabilitation admission and admission scores on the Functional Independence Measure (FIM). Simple linear regression was used to take forward any predictors significant at p < .10 level. Variables that satisfied the significance level were grouped in blocks and entered for regression analyses.ResultsThe 275 patients in this sample had a mean age of 69 years; 62% were female and the mean LOS was 29.6 days. Statistically significant predictors of longer LOS were low admission FIM score, female sex, revision of only the femoral component, 2 or more prior surgeries in the L/Es and 2 or more hip revisions (redo revision). The final model explained 28% of variance in inpatient LOS.ConclusionsA score of 9-14 points lower in admission FIM, female sex, revision of only the femoral component, prior surgeries in the L/Es and redo hip revision are all independent factors associated with 4-6 days longer LOS. These results may facilitate an understanding of bed flow. Additionally, patients with one or a combination of the above characteristics may benefit from enhanced care plans that facilitate achievement of rehabilitation goals for discharge home.

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Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty

Cited by 52 publications

References 40 publications

The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study

The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study

Responsiveness and minimal important differences after revision total hip arthroplasty

Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study

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