Patient Relevant Outcome after Total Hip Replacement in Osteoarthritis

University dissertation from Department of Orthopaedics, Lund University

Abstract: The purpose of the study was to evaluate patient relevant outcome after total hip replacement (THR) in patients with primary osteoarthritis (OA). 247 patients >50 years of age with primary hip OA, operated on with THR (Sept1995—Oct1998), were investigated consecutively and prospectively. 68 of the THR were made with hybrid technique. A preoperative radiographic classification was made. Evaluation with SF-36 and WOMAC was done before surgery and 3, 6, 12 months after surgery. A 3.6-year follow-up was made, which was completed with questions about co-morbidity. An additional functional evaluation for 28 of the patients was made with FAS. For comparison a matched reference group (n=117) was recruited. There was no difference in preoperative or postoperative pain and physical impairment between patients with moderate or severe radiographic OA. The pain and function scores of WOMAC and SF-36 showed greater responsiveness than FAS. Before surgery there were no differences in the WOMAC or SF-36 subscales (except mental health) between patients older or younger than 72. After surgery the younger attained a better score for WOMAC function and all subscales of SF-36 except pain. There were no differences in outcome between patients operated on with hybrid or cemented THR. A higher degree of pain preoperatively and older age predicted a worse outcome in WOMAC function 3.6-years after surgery and low back pain was the only characteristic of the patients with a non-successful result. The patients reached the same level of health related quality of life 3.6 years after THR as a matched reference group, with the exception of physical function. Musculoskeletal co-morbidity was the explanation for this difference. Patients with a poor status before surgery did not attain as good outcome as patients with a better status before surgery. Operative treatment earlier in the course of hip OA could be suggested.

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