Predictors of quality of life outcomes after revision total hip replacement

Abstract

A prospective cohort of 222 patients who underwent revision hip replacement between April 2001 and March 2004 was evaluated to determine predictors of function, pain and activity level between one and two years post-operatively, and to define quality of life outcomes using validated patient reported outcome tools. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at one and two years post-operatively. The dependent outcome variables were the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function and pain scores, and University of California Los Angeles activity scores. The independent variables included patient demographics, operative factors, and objective quality of life parameters, including pre-operative WOMAC, and the Short Form-12 mental component score. There was a significant improvement (t-test, p < 0.001) in all patient quality of life scores. In the predictive model, factors predictive of improved function (original regression analyses, p < 0.05) included a higher pre-operative WOMAC function score (p < 0.001), age between 60 and 70 years (p < 0.037), male gender (p = 0.017), lower Charnley class (p < 0.001) and aseptic loosening being the indication for revision (p < 0.003). Using the WOMAC pain score as an outcome variable, factors predictive of improvement included the pre-operative WOMAC function score (p = 0.001), age between 60 and 70 years (p = 0.004), male gender (p = 0.005), lower Charnley class (p = 0.001) and no previous revision procedure (p = 0.023). The pre-operative WOMAC function score (p = 0.001), the indication for the operation (p = 0.007), and the operating surgeon (p = 0.008) were significant predictors of the activity assessment at follow-up. Predictors of quality of life outcomes after revision hip replacement were established. Although some patient-specific and surgery-specific variables were important, age, gender, Charnley class and pre-operative WOMAC function score had the most robust associations with outcome.

The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: a cohort study

“…Related studies are by trend conform to our study [3,7,31-33]. THR outcome was mainly related to preoperative WOMAC and EQ-5D scores.…”

Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts

“…To match patients, we pooled data and then predicted for each patient the probability ('propensity score') of being treated in Germany using logistic regression. Several preoperative patient characteristics that were found to be associated with post-operative HRQoL in previous clinical studies [16][17][18] were controlled for, including age, gender, preoperative EQ-5D score, living arrangements (alone, co-habitant), Charlson comorbidity score [19], and the number of additionally coded comorbidities not already covered. Post-operative EQ-5D score, change in EQ-5D score, and length of stay were excluded from the set of matching variables.…”

Hip Arthroplasty after Previous Arthrodesis

“…(2) What are the Mayo hip scores and prosthetic survival in patients during the last 20 years? (3) Have the type of arthrodesis, age at the time of arthrodesis, duration of arthrodesis, number of surgeries necessary to achieve arthrodesis, or original diagnosis influenced the outcome?…”