Return to activity following revision total hip arthroplasty

Abstract

Return to activity following revision total hip arthroplasty Background: Demand for revision total hip arthroplasty (RTHA) continues to grow worldwide and is expected to more than double within the next 1-2 decades. The primary aim of this study was to examine return to function following revision THA in a UK population. Patients & methods: We assessed 118 patients (132 RTHAs, mean age 65 years SD 13, range 23 to 88) at a mean follow-up of 7.9 years (SD 4.4) postoperatively. Preoperative age, gender, BMI, social deprivation, operative indication, comorbidities, activity level (UCLA score) and Oxford Hip Scores (OHS) were recorded. Postoperative UCLA score, OHS, EQ-5D, satisfaction levels and performance in activities of daily living (ADLs) were obtained and univariate and multivariate analysis performed. Results: Mean UCLA activity score improved following RTHA (p<0.001): UCLA activity score improved in 37% and was unchanged in 50%; 49% of patients engaged in at least moderate level activities (UCLA score ≥ 6). Patient BMI, gender, age and reason for revision did not influence levels of pain, stiffness or activity at follow up. Preoperative UCLA activity scores (p<0.001) independently predicted long-term UCLA scores. Independent predictors (p<0.05) of poor hip specific function (OHS) following revision included social deprivation, revision for peri-prosthetic fracture and lower preoperative OHS. Difficulties with ADLs were associated with increasing deprivation, ≥3 comorbidities, and revision for periprosthetic fracture or infection (p<0.05). Overall, 79% of patients remained satisfied or very satisfied following revision THA. Following RTHA, 10% suffered a dislocation and 13% required reoperation for complications. Conclusion: Revision THA facilitates long-term return to preoperative levels of physical activity in the majority of patients, though activity levels increase in one third only. Overall over three quarters are satisfied with their outcome, but revision for periprosthetic fracture or dislocation gives the worse overall outcomes and lower satisfaction levels.

Patient-reported outcome after primary and aseptic revision hip arthroplasty: 1-year follow-up of 3,559 primary and 406 revision THAs in an institutional registry

“…78% of patients receiving revision THA rated their function as better 1 year postoperatively. This is in accordance with another study reporting that 79% of patients undergoing revision surgery in the hip joint were satisfied or very satisfied with their surgical results almost 8 years after surgery (16).…”

Patient-reported outcomes after primary or revision total hip arthroplasty: A propensity score-matched Asian cohort study

“…Herman et al also reported that PROMs (SF12- PCS, Harris Hip Score, and WOMAC) for the infection cohort were significantly worse than the noninfected controls [ 41 ]. Other previous studies have shown poor PROMs for revision THA due to dislocation or periprosthetic fracture and infection [ 41 , 42 ]. Turnbull et al reported that revision THA for aseptic loosening was associated with better PROMs (OHS and UCLA activity score) at 7-year follow-up, while revision for periprosthetic fracture had the worst PROMs and recurrent dislocation was associated with lower patient satisfaction [ 42 ].…”

“…Other previous studies have shown poor PROMs for revision THA due to dislocation or periprosthetic fracture and infection [ 41 , 42 ]. Turnbull et al reported that revision THA for aseptic loosening was associated with better PROMs (OHS and UCLA activity score) at 7-year follow-up, while revision for periprosthetic fracture had the worst PROMs and recurrent dislocation was associated with lower patient satisfaction [ 42 ]. There are no previous reports comparing PROMs between revision and re-revision THA [ 43 ].…”

“…However, few studies have examined this association in revision THA. Turnbull et al demonstrated the predictive correlation between pre- and post-operative UCLA activity scores in revision THA at 7-year follow-up [ 42 ]. Our study showed similar results at an even longer 12-year follow-up.…”

Microfluidic Fabrication of Biomimetic Helical Hydrogel Microfibers for Blood‐Vessel‐on‐a‐Chip Applications

“…Over 180 000 patients therefore require total joint replacement surgery in the UK annually, a major operation which can result in incomplete satisfaction and residual symptoms, particularly in younger patients [160][161][162][163]. A rising number of patients also face the prospect of requiring revision joint replacement, a technically more complex and costly procedure with generally inferior clinical results [164][165][166][167][168][169]. Extensive efforts have therefore been made to search for novel and alternative strategies to aid and promote cartilage repair.…”