Operative Diagnosis for Revision Total Hip Arthroplasty is Associated with Patient-reported Outcomes (PROs)

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2013 Jul 23

PMID 23866848

Citations 8

Authors

Jasvinder A Singh

David G Lewallen

Affiliations

Soon will be listed here.

Abstract

Background: Little is known about the impact of the reason for revision total hip arthroplasty (THA) on the outcomes following revision THA. In this study, our objective was to assess the association of operative diagnosis with patient-reported outcomes (PROs) after revision THA.

Methods: We used prospectively collected data from the Mayo Clinic Total Joint Registry that collects pre- and post-operative pain and function outcomes using a validated Hip questionnaire, on all revision THAs from 1993-2005. We used logistic regression to assess the odds of moderate-severe index hip pain and moderate-severe limitation in activities of daily living (ADLs) 2- and 5-years after revision THA. We calculated odds ratios (OR) and 95% confidence intervals (CIs).

Results: For the 2- and 5-year cohorts, the operative diagnosis was loosening/wear/osteolysis in 73% and 75%; dislocation/bone or prosthesis fracture/instability or non-union in 17% and 15%; and failed prior arthroplasty with components removed/infection in 11% and 11%, respectively. In multivariable-adjusted analyses that included preoperative ADL limitations, compared to patients with loosening/wear/osteolysis, patients with dislocation/fracture/instability/non-union had OR of 2.2 (95% CI, 1.3-3.5; p = 0.002) for overall moderate-severe ADL limitation and those with failed prior arthroplasty/infection had OR of 1.6 (95% CI, 1.0-2.8; p = 0.06). At 5-years, ORs were lower and differences were no longer significant. Moderate-severe pain did not differ significantly by diagnosis, at 2- or 5-years in multivariable adjusted analyses, with one exception, i.e. failed prior arthroplasty/infection had a trend towards significance with odds ratio of 1.9 (95% CI, 0.9-3.8; p = 0.07).

Conclusions: Operative diagnosis is independently associated with ADL limitations, but not pain, at 2-years after revision THA. Patients should be informed of the risk of poorer short-term outcomes based on their diagnosis.

Citing Articles

Total Hip Arthroplasty Complications in Patients With Sickle Cell Disease: A Comparison Study.

DeMaio C, Patrick C, Domingue G, Fox J, Dvorak J, Thakral R Arthroplast Today. 2025; 30:101512.

PMID: 39959364 PMC: 11827096. DOI: 10.1016/j.artd.2024.101512.

Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review.

Merenda M, Earnest A, Ruseckaite R, Tse W, Elder E, Hopper I Aesthet Surg J Open Forum. 2024; 6:ojae015.

PMID: 38650972 PMC: 11033681. DOI: 10.1093/asjof/ojae015.

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review.

Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E Eur J Orthop Surg Traumatol. 2023; 34(2):1219-1251.

PMID: 37768398 PMC: 10858160. DOI: 10.1007/s00590-023-03691-y.

Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants.

Abu-Awwad A, Tudoran C, Jr J, Faur C, Tudoran M, Mekeres G Materials (Basel). 2023; 16(4).

PMID: 36837270 PMC: 9966432. DOI: 10.3390/ma16041640.

Revision Hip Arthroplasty in Patient with Acetabulum Migration into Subperitoneal Space-A Case Report.

Kotela A, Lorkowski J, Chmielewski D, Grodzik M, Kotela I Medicina (Kaunas). 2021; 57(1).

PMID: 33396344 PMC: 7824657. DOI: 10.3390/medicina57010030.

References

Singh J, Jensen M, Lewallen D . Patient factors predict periprosthetic fractures after revision total hip arthroplasty. J Arthroplasty. 2012; 27(8):1507-12. PMC: 3360118. DOI: 10.1016/j.arth.2011.12.010. View

Wright J, Young N . A comparison of different indices of responsiveness. J Clin Epidemiol. 1997; 50(3):239-46. DOI: 10.1016/s0895-4356(96)00373-3. View

Deyo R, Cherkin D, Ciol M . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6):613-9. DOI: 10.1016/0895-4356(92)90133-8. View

DRIPPS R, Lamont A, ECKENHOFF J . The role of anesthesia in surgical mortality. JAMA. 1961; 178:261-6. DOI: 10.1001/jama.1961.03040420001001. View

McGrory B, Freiberg A, Shinar A, Harris W . Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. J Arthroplasty. 1996; 11(5):565-71. DOI: 10.1016/s0883-5403(96)80111-2. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Singh J, Lewallen D . Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord. 2010; 11:90. PMC: 2881019. DOI: 10.1186/1471-2474-11-90. View

Weaver F, Hynes D, Hopkinson W, Wixson R, Khuri S, Daley J . Preoperative risks and outcomes of hip and knee arthroplasty in the Veterans Health Administration. J Arthroplasty. 2003; 18(6):693-708. DOI: 10.1016/s0883-5403(03)00259-6. View

Kurtz S, Ong K, Lau E, Mowat F, Halpern M . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5. DOI: 10.2106/JBJS.F.00222. View

10.

Singh J, Lewallen D . Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol. 2009; 28(12):1419-30. PMC: 2963019. DOI: 10.1007/s10067-009-1267-z. View

11.

Singh J, OByrne M, Harmsen W, Lewallen D . Predictors of moderate-severe functional limitation 2 and 5 years after revision total knee arthroplasty. J Arthroplasty. 2010; 25(7):1091-5, 1095.e1-4. PMC: 3895366. DOI: 10.1016/j.arth.2009.07.020. View

12.

Best J . Revision total hip and total knee arthroplasty. Orthop Nurs. 2005; 24(3):174-9. DOI: 10.1097/00006416-200505000-00003. View

13.

McGrory B, Morrey B, Rand J, Ilstrup D . Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty. 1996; 11(1):47-57. DOI: 10.1016/s0883-5403(96)80160-4. View

14.

Davis A, Agnidis Z, Badley E, Kiss A, Waddell J, Gross A . Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am. 2006; 88(4):685-91. DOI: 10.2106/JBJS.E.00150. View

15.

Espehaug B, Havelin L, Engesaeter L, Langeland N, Vollset S . Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop Relat Res. 1998; (351):135-48. View

16.

Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M . Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res. 2007; 465:185-8. DOI: 10.1097/BLO.0b013e3181576035. View

17.

Singh J, Lewallen D . Predictors of activity limitation and dependence on walking aids after primary total hip arthroplasty. J Am Geriatr Soc. 2010; 58(12):2387-93. PMC: 3850176. DOI: 10.1111/j.1532-5415.2010.03182.x. View

18.

Vincent K, Vincent H, Lee L, Weng J, Alfano A . Outcomes after inpatient rehabilitation of primary and revision total hip arthroplasty. Arch Phys Med Rehabil. 2006; 87(8):1026-32. DOI: 10.1016/j.apmr.2006.04.015. View

19.

Koenig K, Huddleston 3rd J, Huddleston H, Maloney W, Goodman S . Advanced age and comorbidity increase the risk for adverse events after revision total hip arthroplasty. J Arthroplasty. 2012; 27(7):1402-1407.e1. DOI: 10.1016/j.arth.2011.11.013. View

20.

Singh J, Gabriel S, Lewallen D . The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res. 2008; 466(11):2717-23. PMC: 2565033. DOI: 10.1007/s11999-008-0399-9. View