The impact of age and preoperative health-related quality of life on patient-reported improvements after total hip arthroplasty

Abstract

BackgroundTotal hip arthroplasty (THA) is a common surgical procedure and approximately 9,500 of these surgeries are performed annually in Denmark. The operation is considered effective and successful with respect to complications, mortality, and implant survival. However, using patient-reported outcome measures, up to 10% of patients are not satisfied with the outcome of their operation. To address this, it is important to find out why some patients experience impaired outcomes after THA. The purpose of this study was to investigate the impact of age and preoperative health-related quality of life (HRQoL) on improvements in HRQoL after THA.MethodsA cohort study was conducted with follow-up at 3 and 12 months. Patients were included from September 2008 to December 2013. We analyzed 1,283 THA cases. HRQoL was measured using the EuroQol-5 Domain. Analyses were carried out with multiple linear regression and adjusted for relevant variables available in the data set.ResultsA significant positive association was found between age and HRQoL outcomes for patients who underwent THA at both 3 (β [regression coefficient] 0.0026, confidence interval [CI] 0.0013; 0.0039, p<0.001) and 12 (β 0.0020 CI 0.0008; 0.0032, p=0.001) months of follow-up. A clinically relevant change was achieved with an increase in age of 12–15 years. A significant negative association was found between preoperative HRQoL and HRQoL outcomes at both 3 (β −0.841 CI −0.886; −0.795, p<0.001) and 12 (β −0.804 CI −0.844; −0.764, p<0.001) months of follow-up.ConclusionContrary to our expectations, older patients had more improvements in HRQoL outcomes after THA. A high preoperative HRQoL seems to inhibit improvements in HRQoLs after THA.

Superior Functional Outcome and Comparable Health-Related Quality of Life after Enhanced Recovery vs. Conventional THA: A Retrospective Matched Pair Analysis

“…In the follow up after 12 months, both groups had a median EQ-5D of 1.0 for the ERAS and non-ERAS groups. The studies of Larsen et al [ 19 ] and Aalund et al [ 20 ] showed comparable results to our study, with a continued rise of the values of EQ-5D to the follow up after 12 months. Preoperatively, both groups showed an inferior score compared to the population norm of Germany.…”

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

“…However, a subgroup analysis of the nondisplaced FNF patients with IF conducted to elaborate the results of the different osteosynthetic treatments (e.g., cancellous screws versus DHS) was not performed in the FAITH trial [37] or in our study. The two large RCTs currently being conducted in Sweden (HipSTHeR trial [38]) and in Denmark (SENSE trial [39]) comparing IF including screw fixation or DHS with THR or Furthermore, overall satisfactory long-term HRQoL has been described in the literature, especially for older patients treated for nondisplaced FNFs with IF as well as for those undergoing primary elective THR [14,40]. In line with recent findings [14,28], we observed that the difference in HRQoL between the IF and HA groups remained proportionate throughout the follow-up period and that the EQ-5D index scores did not differ between the groups.…”

The AAHKS Clinical Research Award: No Evidence for Superior Patient-Reported Outcome Scores After Total Hip Arthroplasty With the Direct Anterior Approach at 1.5 Months Postoperatively, and Through a 5-Year Follow-Up

“…In contrast, the existing literature which analyzes continuous PROM scores may report results that hinge on a small subset of patients who do very well or very poorly. Patients who may be outliers postoperatively are those who are unusually healthy and active preoperatively [42,43]. Graves et al [5] proposed that a selfselection bias of more active patients toward a surgeon performing the direct anterior approach may exist.…”