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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

07.12.2018 | Hip Arthroplasty

Return to activity following revision total hip arthroplasty

verfasst von: Gareth S. Turnbull, Chloe E. H. Scott, Deborah J. MacDonald, Steffen J. Breusch

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 3/2019

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Abstract

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 and methods

We assessed 118 patients (132 RTHAs, mean age 65 years SD 13, range 23–88) 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 periprosthetic 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.

Bozic KJ et al (2015) comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473(6):2131–2138CrossRefPubMed

Kurtz S et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMed

Association AO (2017) Australian Orthopaedic Association National Joint Registry Annual Report. Cited 2017 2nd December, 2017. https://aoanjrr.sahmri.com/annual-reports-2017

Registry NJ (2017) National joint registry 14th annual report, 2016

Pivec R et al (2015) Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty: an analysis of international registry data. J Long Term Eff Med Implants 25(4):269–275CrossRefPubMed

Postler AE et al (2017) Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty. Hip Int 27(2):180–186CrossRefPubMed

Vanhegan IS et al (2012) A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Surg Br 94(5):619–623CrossRefPubMed

Farrar NG, Aker M, Duckett S (2015) A cost analysis of elective hip revision arthroplasty versus periprosthetic hip fracture management in a district general hospital. 97:26–29

Crowe JF, Sculco TP, Kahn B (2003) Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res 413:175–182CrossRef

10.

Lyons RF et al (2018) Periprosthetic hip fractures: a review of the economic burden based on length of stay. J Orthopaed 15:118–121. https://doi.org/10.1016/j.jor.2018.01.006 CrossRef

11.

D’Antonio JA, Capello WN, Naughton M (2012) Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res 470(2):373–381CrossRefPubMed

12.

Gwam CU et al (2017) Current epidemiology of revision total hip arthroplasty in the United States: national inpatient sample 2009 to 2013. J Arthroplasty

13.

Singh JA, Lewallen D (2009) Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol 28(12):1419–1430CrossRefPubMedPubMedCentral

14.

Choi Y-J, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28(1):1–15CrossRefPubMedPubMedCentral

15.

Eisler T et al. Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplast 17(4): 457–462

16.

Barrack RL et al (2006) Revision total hip arthroplasty: the patient’s perspective. Clin Orthop Relat Res 453:173–177CrossRefPubMed

17.

Haddad FS et al. The expectations of patients undergoing revision hip arthroplasty. J Arthroplast 16(1):87–91

18.

Dawson J et al (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 78(2):185–190CrossRefPubMed

19.

Naal FD, Impellizzeri FM, Leunig M (2009) Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res 467(4):958–965CrossRefPubMed

20.

Zahiri CA et al (1998) Assessing activity in joint replacement patients. J Arthroplasty 13(8):890–895CrossRefPubMed

21.

EuroQol (1990) A new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208

22.

Kievit AJ et al (2014) A reliable, valid and responsive questionnaire to score the impact of knee complaints on work following total knee arthroplasty: the WORQ. J Arthroplasty 29(6):1169–1175 (e2) CrossRefPubMed

23.

Biring GS et al (2007) Predictors of quality of life outcomes after revision total hip replacement. J Bone Joint Surg Br 89(11):1446–1451CrossRefPubMed

24.

Bourne RB et al (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRefPubMed

25.

Scott CE et al (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92(9):1253–1258CrossRefPubMed

26.

Von Keudell A et al (2014) Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 21(1):180–184CrossRef

27.

Saleh KJ et al (2003) Functional outcome after revision hip arthroplasty: a metaanalysis. Clin Orthop Relat Res 416:254–264

28.

Jain R, Schemitsch EH, Waddell JP (2000) Cementless acetabular revision arthroplasty. Can J Surg 43(4):269–275PubMedPubMedCentral

29.

Jain R, Schemitsch EH, Waddell JP (2000) Functional outcome after acetabular revision with roof reinforcement rings. Can J Surg 43(4):276–282PubMedPubMedCentral

30.

MacWilliam CH et al (1996) Patient-related risk factors that predict poor outcome after total hip replacement. Health Serv Res 31(5):623–638PubMedPubMedCentral

31.

Davis AM et al (2006) Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am 88(4):685–691PubMed

32.

Watts CD et al (2016) Morbidly obese vs non-obese aseptic revision total hip arthroplasty: surprisingly similar outcomes. J Arthroplasty 31(4):842–845CrossRefPubMed

33.

Fisher DA et al (2007) Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 22(6 Suppl 2):39–42CrossRefPubMed

34.

Houdek MT et al (2015) Morbid obesity: a significant risk factor for failure of two-stage revision total hip arthroplasty for infection. J Bone Joint Surg Am 97(4):326–332CrossRefPubMed

35.

Thomasson E et al (2001) Perioperative complications in revision hip surgery. Ortop Traumatol Rehabil 3(1):38–40PubMed

36.

Clement ND et al (2013) Socioeconomic status affects the Oxford knee score and short-form 12 score following total knee replacement. Bone Joint J 95-B(1):52–58CrossRefPubMed

37.

Clement ND et al (2011) Socioeconomic status affects the early outcome of total hip replacement. J Bone Joint Surg Br 93(4):464–469CrossRefPubMed

38.

Neuburger J et al (2013) Socioeconomic differences in patient-reported outcomes after a hip or knee replacement in the English National Health Service. J Public Health 35(1):115–124CrossRef

39.

Springer BD et al (2017) Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplasty Today 3(2):137–140CrossRefPubMedPubMedCentral

40.

Singh JA, Lewallen DG (2013) Operative diagnosis for revision total hip arthroplasty is associated with patient-reported outcomes (PROs). BMC Musculoskelet Disord 14(1):210CrossRefPubMedPubMedCentral

41.

Davis AM et al (2008) Waiting for hip revision surgery: the impact on patient disability. Can J Surg 51(2):92–96PubMedPubMedCentral

Titel: Return to activity following revision total hip arthroplasty
verfasst von: Gareth S. Turnbull
Chloe E. H. Scott
Deborah J. MacDonald
Steffen J. Breusch
Publikationsdatum: 07.12.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 3/2019
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3090-y

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Return to activity following revision total hip arthroplasty