1-year trajectories of patients undergoing primary total hip arthroplasty: Patient reported outcomes and resource needs according to education level

Abstract

Background Objectives were first to evaluate by education level one-year trajectories of pain, function and general health, as well as hospital resource and medication needs in patients undergoing primary total hip arthroplasty (THA); and second, to evaluate whether outcome differences are related to existing baseline differences in health and disease severity. Methods We included all primary THAs from a public hospital-based prospective arthroplasty registry, performed in a high-income country 2010 to 2017. Education was classified in three levels: ≤8years of schooling (low), 9-12years (medium), and ≥13years (high). Pain and function prior to and one-year after surgery were assessed with the Western Ontario McMaster Universities score (WOMAC) and general health with the 12-item short-form health survey (SF-12). Results Overall 963 patients were included, 340 (35.3%) with low, 306 (31.8%) with medium, and 317 (32.9%) with high education. With increasing educational level preoperative scores for pain, function and SF-12 mental health component increased. One year after surgery improvement was observed in all education categories for WOMAC pain and function, SF-12 mental and physical component. However, absolute postoperative scores remained lower in all four domains for the low education group. After adjustment for baseline characteristics differences were much attenuated and no longer significant. There was also greater resource need in low educated patients. Conclusions The inferior absolute results one year after surgery in less educated patients were largely due to older age, worse preoperative health and greater symptom severity calling for greater attention to timely and equal management, for more targeted perioperative care and increased support for the lower education group.

Postoperative pain trajectories in total hip arthroplasty

“…In the context of our findings, it is conceivable that the subset of patients discharged to rehabilitation and therapy services might be more prone to pain catastrophizing due to the compounded stress of socio-economic factors, and potentially, the lack of a supportive home environment. A study by Gonzalez et al 34 also offers corroborative evidence, showing that post-THA patients discharged to rehabilitation facilities often report worse pain outcomes, a trend linked to lower educational levels and lower pre- and postoperative mental health scores. This finding aligns with our observations, highlighting the significant impact of mental health and socioeconomic factors on post-THA recovery trajectories, especially in the context of discharge disposition.…”