The Frank Stinchfield Award: The Impact of Socioeconomic Factors on Outcome After THA: A Prospective, Randomized Study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Most studies of total hip arthroplasty (THA) focus on the effect of the type of implant on the clinical result. Relatively little data are available on the impact of the patient’s preoperative status and socioeconomic factors on the clinical results following THA.
We determined the relative importance of patient preoperative and socioeconomic status compared to implant and technique factors in predicting patient outcome as reflected by scores on commonly utilized rating scales (eg, Harris Hip Score, WOMAC, SF-12, degree of patient satisfaction, or presence or severity of thigh pain) following cementless THA.
All patients during the study period were offered enrollment in a prospective, randomized study to receive either a titanium, tapered, proximally coated stem; or a Co-Cr, cylindrical, extensively coated stem; 102 patients were enrolled. We collected detailed patient data preoperatively including diagnosis, age, gender, insurance status, medical comorbidities, tobacco and alcohol use, household income, educational level, and history of treatment for lumbar spine pathology. Clinical evaluation included Harris Hip Score, SF-12, WOMAC, pain drawing, and UCLA activity rating and satisfaction questionnaire. Implant factors included stem type, stem size, fit in the canal, and stem-bone stiffness ratios. Minimum 2 year followup was obtained in 95% of the enrolled patients (102 patients).
Patient demographics and preoperative status were more important than implant factors in predicting the presence of thigh pain, dissatisfaction, and a low hip score. The most predictive factors were ethnicity, educational level, poverty level, income, and a low preoperative WOMAC score or preoperative SF-12 mental component score. No implant parameter correlated with outcome or satisfaction.
Socioeconomic factors and preoperative status have more impact on the clinical outcome of cementless THA than implant related factors.
Level of Evidence
Level I, prospective, randomized clinical trial. See the guidelines online for a complete description of level of evidence.
- Akhavan S, Matthiesen MM, Schulte L, Penoyar T, Kraay MJ, Rimnac CM, Goldberg VM. Clinical and histologic results related to a low-modulus composite total hip replacement stem. J Bone Joint Surg Am. 2006;88:1308–1314. CrossRef
- Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.
- Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89:893–900. CrossRef
- Barrack RL, Mulroy RD, Jr., Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.
- Barrack RL, Paprosky W, Butler RA, Palafox A, Szuszczewicz E, Myers L. Patients’ perception of pain after total hip arthroplasty. J Arthroplasty. 2000;15:590–596. CrossRef
- Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
- Belmont PJ, Jr, Powers CC, Beykirch SE, Hopper RH, Jr, Engh CA, Jr, Engh CA. Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years. A concise follow-up of previous reports. J Bone Joint Surg Am. 2008;90:1524–1530. CrossRef
- Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res.468:57–63.
- Bozic K. Single mini-incision has some perioperative advantages over standard-incision total hip replacement. J Bone Joint Surg Am. 2009;91:1279. CrossRef
- Brinker MR, Lund PJ, Barrack RL. Demographic biases of scoring instruments for the results of total knee arthroplasty. J Bone Joint Surg Am. 1997;79:858–865.
- Brinker MR, Lund PJ, Cox DD, Barrack RL. Demographic biases found in scoring instruments of total hip arthroplasty. J Arthroplasty. 1996;11:820–830. CrossRef
- Burnett RS, Haydon CM, Rorabeck CH, Bourne RB. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res. 2004:12–25.
- Confalonieri N, Manzotti A, Montironi F, Pullen C. Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. Orthopedics. 2008;31(10 Suppl 1).
- Danesh-Clough T, Bourne RB, Rorabeck CH, McCalden R. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty. 2007;22:195–203. CrossRef
- Dixon MC, Scott RD, Schai PA, Stamos V. A simple capsulorrhaphy in a posterior approach for total hip arthroplasty. J Arthroplasty. 2004;19:373–376. CrossRef
- Dujovne AR, Bobyn JD, Krygier JJ, Miller JE, Brooks CE. Mechanical compatibility of noncemented hip prostheses with the human femur. J Arthroplasty. 1993;8:7–22. CrossRef
- Dunlop DD, Manheim LM, Song J, Sohn MW, Feinglass JM, Chang HJ, Chang RW. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008;46:200–208. CrossRef
- Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990:107–128.
- Escalante A, Espinosa-Morales R, del Rincon I, Arroyo RA, Older SA. Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status. Arthritis Rheum. 2000;43:390–399. CrossRef
- Federal Registry: Federal Poverty Income Guidelines for Fiscal Year 2003. February 7, 2003 ed. Washington, D.C.: Government Printing Office:6456–6458.
- Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res. 2008;466:2597–2604. CrossRef
- Groeneveld PW, Kwoh CK, Mor MK, Appelt CJ, Geng M, Gutierrez JC, Wessel DS, Ibrahim SA. Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum. 2008;59:730–737. CrossRef
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
- Hennessy DW, Callaghan JJ, Liu SS. Second-generation extensively porous-coated THA stems at minimum 10-year followup. Clin Orthop Relat Res. 2009;467:2290–2296. CrossRef
- Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Differences in expectations of outcome mediate African American/white patient differences in “willingness” to consider joint replacement. Arthritis Rheum. 2002;46:2429–2435. CrossRef
- Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Med Care. 2002;40:I44–I51. CrossRef
- Laupacis A, Bourne R, Rorabeck C, Feeny D, Tugwell P, Wong C. Comparison of total hip arthroplasty performed with and without cement : a randomized trial. J Bone Joint Surg Am. 2002;84-A:1823–1828.
- Lavernia C, D’Apuzzo M, Rossi MD, Lee D. Is postoperative function after hip or knee arthroplasty influenced by preoperative functional levels? J Arthroplasty. 2009;24:1033–1043. CrossRef
- Lavernia CJ, Lee D, Sierra RJ, Gomez-Marin O. Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients. J Arthroplasty. 2004;19:978–985. CrossRef
- Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–1519. CrossRef
- Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;140:1–55.
- Lombardi AV, Jr., Berend KR, Mallory TH, Skeels MD, Adams JB. Survivorship of 2000 tapered titanium porous plasma-sprayed femoral components. Clin Orthop Relat Res. 2009;467:146–154. CrossRef
- MacDonald SJ, McCalden RW, Chess DG, Bourne RB, Rorabeck CH, Cleland D, Leung F. Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2003:282–296.
- Mahomed N, Sledge C, Daltroy L, Fossel A, Katz J. Self-administered patient satisfaction scale for joint replacement arthroplasty. J Bone Joint Surg Br. 1998;80(Suppl 1):9.
- Mancuso CA, Jout J, Salvati EA, Sculco TP. Fulfillment of patients’ expectations for total hip arthroplasty. J Bone Joint Surg Am. 2009;91:2073–2078. CrossRef
- McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009;91:773–782. CrossRef
- Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB. Does total knee replacement restore normal knee function? Clin Orthop Relat Res. 2005:157–165.
- Parvizi J, Keisu KS, Hozack WJ, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem. J Arthroplasty. 2004;19:151–156. CrossRef
- Ritter MA, McAdoo WG. A method for determining success following total hip replacement surgery. Clin Orthop Relat Res. 1979:44–49.
- Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.
- Santori FS, Manili M, Fredella N, Tonci Ottieri M, Santori N. Ultra-short stems with proximal load transfer: Clinical and radiographic results at five-year follow-up. Hip Int. 2006;16 Suppl 3:31–39.
- U.S. Census Bureau. QuickFacts - Orleans Parish, Louisiana. Retrieved December 29, 2008, from http://quickfacts.census.gov/qfd/states/22/22071.html.
- Wan Z, Dorr LD, Woodsome T, Ranawat A, Song M. Effect of stem stiffness and bone stiffness on bone remodeling in cemented total hip replacement. J Arthroplasty. 1999;14:149–158. CrossRef
- Ware JE J, Kosinski M, Keller SD. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales, 3rd ed. Lincoln, RI: QualityMetric Incorporated; 1998.
- Young NL, Cheah D, Waddell JP, Wright JG. Patient characteristics that affect the outcome of total hip arthroplasty: a review. Can J Surg. 1998;41:188–195.
- The Frank Stinchfield Award: The Impact of Socioeconomic Factors on Outcome After THA: A Prospective, Randomized Study
Clinical Orthopaedics and Related Research®
Volume 469, Issue 2 , pp 339-347
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Starkville Orthopedic Clinic, Starkville, MS, USA
- 2. Dauterive Orthopaedics & Sports Medicine, New Iberia, LA, USA
- 3. Department of Biostatistics, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
- 4. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO, 63110, USA