The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study

Abstract

ObjectivesTo identify patient characteristics and surgical factors associated with patient-reported outcomes over 5 years following primary total hip replacement (THR).DesignProspective cohort study.SettingSeven hospitals across England and Scotland.Participants1431 primary hip replacements for osteoarthritis.Main outcome measuresThe Oxford Hip Score (OHS) was collected preoperatively and each year up to 5 years postoperatively. Repeated measures such as linear regression modelling are used to identify patient and surgical predictors of outcome and describe trends over time.ResultsThe majority of patients demonstrated substantial improvement in pain/function in the first year after surgery—between 1 and 5 years follow-up, there was neither further improvement nor decline. The strongest determinant of attained postoperative OHS was the preoperative OHS—those with worse preoperative pain/function had worse postoperative pain/function. Other predictors with small but significant effects included: femoral component offset—women with an offset of 44 or more had better outcomes; age—compared to those aged 50–60, younger (age <50) and older patients (age >60) had worse outcome, increasing body mass index (BMI), more coexisting diseases and worse Short Form 36 mental health (MH) was related to worse postoperative pain/function. Assessment of change in OHS between preoperative and postoperative assessments revealed that patients achieved substantial and clinically relevant symptomatic improvement (change), regardless of variation in these patient and surgical factors.ConclusionsPatients received substantial benefit from surgery, regardless of their preoperative assessments and surgical characteristics (baseline pain/function, age, BMI, comorbidities, MH and femoral component offset). Further research is needed to identify other factors that can improve our ability to identify patients at risk of poor outcomes from THR surgery.

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

“…When compared with our earlier report of patients undergoing this procedure [33], there has been a trend toward a decline in the recorded OHS, which is typical of aging in this population [13,20]. The WOMAC score did not show any signs of deterioration in comparison with our earlier series, in contrast to the OHS.…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…We identified eight studies that reported the association between BMI and a long-term patient-reported outcome in multivariable analysis. 103,104,[127][128][129]132,133,135 If reported in the studies we identified, patients had broadly similar average BMIs to those reported in the National Joint Registry for England and Wales 3 and the APEX cohort described in Chapters 6 and 7.…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Judge and colleagues 128 followed up 1375 patients (64% eligible) who had received a specific design of THR prosthesis at seven UK centres 5 years after surgery. The mean BMI of patients in the cohort followed up was 27.6 kg/m 2 (SD 4.8 kg/m 2 ) and it was treated as a continuous variable.…”

“…In this section we summarise results from 14 studies of pre-operative BMI, mental health, pain and physical function as predictors of long-term patient-reported outcomes. 31,103,104,[125][126][127][128][129][130][131][132][133][134][135] Study characteristics are summarised in Appendix 5 with brief details in Table 4. …”

“…Searches identified eight studies that specifically focused on the relationship between BMI and patient-reported outcomes at ≥ 12 months after THR. Three studies included patients from multiple centres, [127][128][129] and five studies were conducted at a single centre. 103,104,132,133,135 Study details are summarised in Table 4.…”