Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty

Sato, Eleanor H.; Stevenson, Kimberly L.; Blackburn, Brenna; Peters, Christopher L.; Archibeck, Michael J.; Pelt, Christopher E.; Gililland, Jeremy M.; Anderson, Lucas A.

doi:10.1016/j.arth.2023.04.012

Cited by 7 publications

(6 citation statements)

References 57 publications

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“…This closely aligns with recovery patterns of patients undergoing THA in the literature. 28,29 The majority of patients in our study (91.6%) exhibited typical and anticipated recovery patterns. However, through the use of GMM we were able to delineate the presence of two subgroups in our data, both characterized by high preoperative pain levels.…”

Section: Discussionmentioning

confidence: 54%

Postoperative pain trajectories in total hip arthroplasty

Omran,

Waren,

Schwarzkopf

2024

Bone Jt Open

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AimsTotal hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories.MethodsThis retrospective cohort study analyzed THA patients at a large academic centre (NYU Langone Orthopedic Hospital, New York, USA) from January 2018 to January 2023, who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questionnaires, collected preoperatively at one-, three-, six-, 12-, and 24-month follow-up times. Growth mixture modelling (GMM) was used to model the trajectories. Optimal model fit was determined by Bayesian information criterion (BIC), Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR-LRT), posterior probabilities, and entropy values. Association between trajectory groups and patient characteristics were measured by multinomial logistic regression using the three-step approach.ResultsAmong the 1,249 patients, a piecewise GMM model revealed three distinct pain trajectory groups: 56 patients (4.5%) in group 1; 1,144 patients (91.6%) in group 2; and 49 patients (3.9%) in group 3. Patients in group 2 experienced swift recovery post-THA and minimal preoperative pain. In contrast, groups 1 and 3 initiated with pronounced preoperative pain; however, only group 3 exhibited persistent long-term pain. Multinomial regression indicated African Americans were exceedingly likely to follow trajectory groups 1 (odds ratio (OR) 2.73) and 3 (OR 3.18). Additionally, odds of membership to group 3 increased by 12% for each BMI unit rise, by 19% for each added postoperative day, and by over four if discharged to rehabilitation services (OR 4.07).ConclusionThis study identified three distinct pain trajectories following THA, highlighting the role of individual patient factors in postoperative recovery. This emphasizes the importance of preoperatively addressing modifiable risk factors associated with suboptimal pain trajectories, particularly in at-risk patients.Cite this article: Bone Jt Open 2024;5(3):174–183.

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Section: Discussionmentioning

confidence: 54%

Postoperative pain trajectories in total hip arthroplasty

Omran,

Waren,

Schwarzkopf

2024

Bone Jt Open

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“…However, HOOS functional domains significantly increased in the first two months post-operative, with improvements exceeding the minimally clinically important differences (MCIDs). Similarly, Sato et al [ 41 ] reported the greatest increases in the HOOS subdomain of mobility in the first month post-operative while select functional metrics (stairs climbed, gait speed and asymmetry) decreased in the first month following TKA. Given that physical performance remains lower than pre-operative during the early post-operative period, the findings of Bolkensteijn et al and Sato et al in conjunction with ours suggest that gait quality metrics may be a more sensitive determinant of functional recovery.…”

Section: Discussionmentioning

confidence: 91%

“…Secondary outcomes include range of motion, PROMs (Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and EuroQol 5-dimension 5-level (EQ5D-5L)) collected pre-operatively and at one, three, six, and twelve months post-operative, and Apple health kit data (step counts, flights of stairs climbed, gait quality metrics). Select secondary outcomes have been previously reported for the longitudinal cohort [ 38 , 41 ]. The present study reviewed 30 weeks of passively collected gait quality metrics.…”

Section: Methodsmentioning

confidence: 99%

“…While Sato et al [ 41 ] demonstrated that gait quality metrics are negatively affected by THA through the first month and exceed baseline by the third month post-operative, we are unaware of any studies that have continuously monitored gait quality recovery during the early post-operative period. Furthering the body of knowledge surrounding the recovery of physical function may benefit surgeons and patients and allow for individual-based, targeted interventions by healthcare providers.…”

Section: Introductionmentioning

confidence: 95%

“…To our knowledge, only one study has used passively collected, smartphone-based IMU data to investigate recovery trajectories following THA. Sato et al [ 41 ] measured PROMs, step count, stairs climbed, walking speed, and asymmetry immediately post-operative and at one, three, six, and twelve months post-operative. Pain and mobility PROMs and step counts increased significantly in the first month post-operative, whereas stairs climbed, walking speed and asymmetry all declined in the first month post-operative and did not exceed pre-operative values until three months post-operative.…”

Section: Introductionmentioning

confidence: 99%

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Stepping Beyond Counts in Recovery of Total Hip Arthroplasty: A Prospective Study on Passively Collected Gait Metrics

Fary

Cholewa

Abshagen

et al. 2023

Sensors

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Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but are time-intensive and previously could only be performed in a lab. Smartphone sensor data and algorithmic advances presently allow for the passive collection of qualitative gait metrics. The purpose of this prospective study was to observe the recovery of physical function following THA by assessing passively collected pre- and post-operative gait quality metrics. This was a multicenter, prospective cohort study. From six weeks pre-operative through to a minimum 24 weeks post-operative, 612 patients used a digital care management application that collected gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-sample t-test. Recovery was defined as the post-operative week when the respective gait metric was no longer statistically inferior to the pre-operative value. To control for multiple comparison error, significance was set at p < 0.002. Walking speeds and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-post-operative (p < 0.001). Walking speed (1.00 ± 0.14 m/s, p = 0.04), step length (0.58 ± 0.06 m/s, p = 0.02), asymmetry (14.5 ± 19.4%, p = 0.046), and double support percentage (31.6 ± 1.5%, p = 0.0089) recovered at 9, 8, 7, and 10 weeks post-operative, respectively. Walking speed, step length, asymmetry, and double support all recovered beyond pre-operative values at 13, 17, 10, and 18 weeks, respectively (p < 0.002). Functional recovery following THA can be measured via passively collected gait quality metrics using a digital care management platform. The data suggest that metrics of gait quality are most negatively affected two weeks post-operative; recovery to pre-operative levels occurs at approximately 10 weeks following primary THA, and follows a slower trajectory compared to previously reported step count recovery trajectories.

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Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference

Dong,

Sroka,

Campbell

et al. 2024

Journal of Orthopaedic Trauma

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Objective: To determine the postoperative trajectory and recovery of patients who undergo Lisfranc ORIF using PROMIS physical function (PF) and pain interference (PI). Methods: Design: Retrospective cohort study Setting: Level 1 trauma center Patient Selection Criteria: Patients who underwent Lisfranc ORIF between January 2002 and December 2022 with documented PROMIS PF and/or PI scores after surgery. Outcome Measures and Comparisons: PROMIS PF and PI were mapped over time up to 1 year after surgery. A sub-analysis was performed to compare recovery trajectories between high and low energy injuries. Results: A total of 182 patients were included with average age of 38.7 (SD 15.9) years (59 high energy and 122 low energy injuries). PROMIS PF scores at 0-weeks, 6-weeks, 12-weeks, 24-weeks, and 48-weeks were 30.2, 31.4, 39.2, 43.9, and 46.7, respectively. There was significant improvement in PROMIS PF between 6-12 weeks (p<0.001), 12-24 weeks (p<0.001), and 24-48 weeks (p=0.022). A significant difference in PROMIS PF between high and low energy injuries was seen at 0-weeks (28.4 vs.31.4, p=0.010). PROMIS PI scores, at 0-weeks, 6-weeks, 12-weeks, 24-weeks, and 48-weeks were 62.2, 58.5, 56.6, 55.7, and 55.6, respectively. There was significant improvement in PROMIS PI 0-6 weeks (p=0.016). A significant difference in PROMIS PI between high and low energy injuries was seen at 48-weeks with scores of (58.6 vs. 54.2, p=0.044). Conclusions: After Lisfranc ORIF, patients can expect improvement in physical function up to one year after surgery, with the biggest improvement in PROMIS physical function scores between 6-12 weeks and PROMIS pain interference scores between 0-6 weeks after surgery. Regardless energy type, Lisfranc injuries seem to regain comparable physical function by 6-12 months after surgery. However, patients with higher energy Lisfranc injuries should be counseled that these injuries may lead to worse pain interference at one year after surgery as compared to lower energy injuries. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty

Cited by 7 publications

References 57 publications

Postoperative pain trajectories in total hip arthroplasty

Postoperative pain trajectories in total hip arthroplasty

Stepping Beyond Counts in Recovery of Total Hip Arthroplasty: A Prospective Study on Passively Collected Gait Metrics

Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference

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