Psychosocial and geriatric correlates of functional status after total hip replacement

Abstract

Objective. To determine whether psychosocial factors, chronic diseases, and common geriatric problems are associated with poor physical function 3 years after primary total hip replacement (THR). Methods. We studied a sample of Medicare recipients in Ohio, Pennsylvania, and Colorado (n ‫؍‬ 922) who underwent primary THR in 1995 (mean ؎ SD age 73.1 ؎ 5.6 years, 32% men). Participants completed a questionnaire regarding lifestyle factors, medical history, and quality of life ϳ3 years after the surgery. Physical function was measured using the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index. We assessed the relationship between functional outcome 3 years postsurgery and 4 predictor domains: pain or complications in the operated hip, other musculoskeletal comorbidity, medical factors (obesity, chronic medical comorbidity, rheumatoid arthritis, and such common geriatric problems as falls, poor balance, or incontinence), and psychosocial factors (mental health, regular alcohol consumption, smoking, provider role, living alone, and education). Results. Ten percent of subjects had poor functional status. In a logistic regression model controlling for sex and age, the following factors were associated with an increased risk for poor functional status (in order of importance): pain in the back or lower extremity, severe pain in the operated hip, poor mental health, more than 1 common geriatric problem, obesity, and less than college education. Conclusion. Pain in the operated hip was strongly associated with poor functional status 3 years after THR. However, other factors associated with poor functional status were not related to the hip. Our results suggest that a comprehensive assessment of functional status in elderly THR patients should include assessment of common geriatric problems, mental health status, and weight.

Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

“…However, groups incorporating these factors found that education was an independent predictor of OA and surgical outcomes [2,4,10,13,18]. Biases may be introduced if considering the excluded determinants because there may be reverse causation between OA and occupation and/or income.…”

“…In the literature, associations between education and surgical outcomes have been explored using numerous patient-reported outcome measures [2,8,16,24]. When investigating postoperative function, an American study found that lack of a college education was associated with poorer function after THA [2].…”

“…When investigating postoperative function, an American study found that lack of a college education was associated with poorer function after THA [2]. In a German population, positive associations were found with increases in the WOMAC in patients who completed their education after 12 years as compared with those with only 8 years of education; however, it is not clear whether these improvements were in all three WOMAC subscales [24].…”

“…Finally, when investigating the effect of socioeconomic status on health, education is the least likely factor to be changed by disease [10]. Even so, there are differing accounts regarding whether an individual's socioeconomic status is associated with outcomes like functional status, HRQoL, and satisfaction after surgery [2,8,16,24]. For analyses of this sort, many of the groups studied have been relatively small with patient populations of 1000 or less.…”

Depression and Osteoarthritis: Impact on Disability

“…Primarily affecting the articular cartilage lining of freely moving joints, and commonly attributed to the aging process, this highly debilitating disease can be aggravated by a variety of medical comorbidities and biological factors other than age [6][7][8][9][10][11][12][13][14][15]. Depression, a frequently observed condition in the older population as well as among people with chronic and/or chronically painful health conditions is another aggravating factor [12,[16][17][18][19][20][21][22][23][24]. Given that osteoarthritis is largely irreversible and that older people are more likely than younger persons to have this condition, the goal of this editorial was to provide a brief overview of the role of depression in the pathway from osteoarthritis pathology to disability and to make appropriate recommendations for advancing clinical practice in this area [9].…”