Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

Abstract

BackgroundThis systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA).MethodsWe performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects.ResultsThirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI.ConclusionThere is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups.Trial registrationThis systematic review was registered in Prospero, registration number RD42014009977.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1070-3) contains supplementary material, which is available to authorized users.

Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study

“…The age difference between participants and nonparticipants may represent a selection bias in this study, and thus affect the representativeness of the sample. As also reported in the literature [48, 49], increasing age predicted worse recovery in this study. We can therefore assume that this does not directly impede the validity of our findings.…”

Advanced decision‐making using patient‐reported outcome measures in total joint replacement

“…At the process level, AI and DL applied to different preoperative variables are shown to predict length of stay, inpatient charges, and discharge disposition prior to undergoing primary TKR 56 . Facilitating dialog through greater patient involvement in the decision‐making process may also mean lengthier discussions and even greater utilization 57 . While decision aids in some orthopedic practices have shown a reduction in surgical rates, perhaps due to more informed decision‐making, 25 others have not observed any differences in patients selecting surgery whether or not they received a decision aid 21 .…”

The Virtue of Optimistic Realism- Expectation Fulfillment Predicts Patient-Rated Global Effectiveness of Total Hip Arthroplasty

“…Yet, about one third suffer from persistent postoperative pain after THA and 3 to 16% report being dissatis ed with the outcome [10][11][12][13][14]. Several preoperative risk factors for dissatisfaction with surgical outcomes have been identi ed with high consistency across studies: higher age, female gender, comorbidities, associated conditions affecting walking capacity, mental distress, higher pain, and lower socioeconomic status [13,[15][16][17][18].…”

“…Scienti c interest in preoperative expectations modulating patient-reported outcomes has been increasing over the last years producing largely inconsistent results [17].…”

“…Owing to the low methodological study quality and heterogeneity of construct de nitions and measurements [17,[22][23][24], the exact nature of the relationship between expectations and outcome still remains a matter of controversy [22]. Some studies nd patient satisfaction to be mainly predicted by postoperative improvement in symptoms and function, irrespective of prior expectations or expectation ful llment [23].…”