Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

Abstract

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.ObjectiveTo evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.SettingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.ParticipantsA total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA.Outcome measures(1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.ResultsPerioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.ConclusionsIndependent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.

The association between frailty and mortality among lower limb arthroplasty patients: a systematic review and meta-analysis

“…Three studies [20,22,24] were prospective cohort studies, whereas the remaining six were retrospective cohort studies [17-19, 21-23, 25-28]. The countries represented ranged from the United States to Europe, with eight in the United States [17,20,21,[24][25][26][27][28], one in the United Kingdom [22], one in Denmark [23], and two in Canada [18,19]. All these studies were conducted in hospital settings [17][18][19][20][21][22][23][24][25][26][27][28].…”

“…The countries represented ranged from the United States to Europe, with eight in the United States [17,20,21,[24][25][26][27][28], one in the United Kingdom [22], one in Denmark [23], and two in Canada [18,19]. All these studies were conducted in hospital settings [17][18][19][20][21][22][23][24][25][26][27][28]. The prevalence of frailty ranged from 3.1 to 37.4%.…”

“…Overall, through the investigator including patients in the full-age group, the average patient age in most studies remained older than 65 years. Three studies [ 20 , 22 , 24 ] were prospective cohort studies, whereas the remaining six were retrospective cohort studies [ 17 – 19 , 21 – 23 , 25 – 28 ]. The countries represented ranged from the United States to Europe, with eight in the United States [ 17 , 20 , 21 , 24 – 28 ], one in the United Kingdom [ 22 ], one in Denmark [ 23 ], and two in Canada [ 18 , 19 ].…”

“…Numerous studies have examined the association between frailty and postoperative mortality in patients with lower limb arthroplasty, with the majority demonstrating a clear link between increasing frailty and poor outcomes [17][18][19][20][21]. There was no correlation between frailty and mortality in individuals with lower limb arthroplasty in two trials [22,23]. Numerous studies have attempted to establish a link between the frailty index and mortality [24][25][26][27][28].…”

Identifying Frailty in Thermal/Spa Clinical Setting: A Cross-Sectional Study

“…Frailty is a geriatric syndrome characterized by reduced physiological reserves, with a consequent increased vulnerability to adverse health outcomes, including diseases, disability and mortality (1). Furthermore, frailty can moderate the effects of interventions on clinical outcomes, such as disease treatments (2) and surgery (3). Therefore, identifying this syndrome in the context of the treatment of other health conditions may be crucial to adapt the intervention and increase its effectiveness.…”