Abstract
Purpose
The majority of patients experience a significant improvement in quality of life and function after total hip replacement (THR). It has recently been shown that age and good pre-operative function are the best predictors of postoperative function. When patients fail to achieve a satisfactory outcome, a cause is often identified. Where there is no identifiable cause, advice, follow-up and management is not clear. The aim of this study was to determine the long-term outcome of patients who had early poor function, but no identifiable cause.
Methods
From a regional database, we identified 1,564 patients who underwent unilateral THR between 1998 and 2004 and who were without complication or subsequent bilateral procedure at six months. These patients were divided into two groups according to their Harris hip score (HHS) at this stage: group A consisted of 270 patients with a ‘poor’ result (HHS less than 70). Group B consisted of 1,294 patients with a ‘good’ or ‘excellent’ result (HHS 70 or above). The patients were reviewed at five years. One hundred and ten patients from group A and 980 from group B completed five-year follow-up without further identifiable complication.
Results
Those with poor or fair function at six months were at an increased risk of developing an identified complication by five years including dislocation (OR 5.7, 95 % CI 1.8–18.2), deep infection (OR 9.8, 95%CI 2.9–37.7) and death (OR 1.6, 95 % CI 1.1–2.3). There was a greater rate of revision in group A versus group B (OR 5.7, 95 % CI 2.9–11). The overall function measured by the Harris hip score significantly improved in group A, but never reached that of those with good or excellent function at six months (HHS 76.2 versus 90.3, P < 0.001).
Conclusions
Patients with poor function at six months, but no obvious cause, are at higher risk of developing complications by five years. This group may benefit from more regular arthroplasty review and intervention.
Similar content being viewed by others
References
Ng CY, Ballantyne JA, Brenkel IJ (2007) Quality of life and functional outcome after primary total hip replacement. A five-year follow-up. J Bone Joint Surg Br 89(7):868–873. doi:10.1302/0301-620X.89B7.18482
Anakwe RE, Jenkins PJ, Moran M (2011) Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty 26(2):209–213. doi:10.1016/j.arth.2010.03.013
Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2(1):e000435. doi:10.1136/bmjopen-2011-000435
Bhave A, Marker DR, Seyler TM, Ulrich SD, Plate JF, Mont MA (2007) Functional problems and treatment solutions after total hip arthroplasty. J Arthroplasty 22(6 Suppl 2):116–124. doi:10.1016/j.arth.2007.04.025
Dussault RG, Goldman AB, Ghelman B (1977) Radiologic diagnosis of loosening and infection in hip prostheses. J Can Assoc Radiol 28(2):119–123
Johnsson R, Thorngren KG (1989) Function after total hip replacement for primary osteoarthritis. Int Orthop 13(4):221–225
Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32(5):597–604. doi:10.1007/s00264-007-0364-3
Classen T, Zaps D, Landgraeber S, Li X, Jager M (2013) Assessment and management of chronic pain in patients with stable total hip arthroplasty. Int Orthop 37(1):1–7. doi:10.1007/s00264-012-1711-6
Harris WH (1969) 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 51(4):737–755
Pacault-Legendre V, Courpied JP (1999) Survey of patient satisfaction after total arthroplasty of the hip. Int Orthop 23(1):23–30
Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN (2002) Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 46(12):3327–3330. doi:10.1002/art.10631
Riediger W, Doering S, Krismer M (2010) Depression and somatisation influence the outcome of total hip replacement. Int Orthop 34(1):13–18. doi:10.1007/s00264-008-0688-7
Mancuso CA, Sculco TP, Salvati EA (2003) Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 18(7):872–878
van den Akker-Scheek I, Zijlstra W, Groothoff JW, Bulstra SK, Stevens M (2008) Physical functioning before and after total hip arthroplasty: perception and performance. Phys Ther 88(6):712–719. doi:10.2522/ptj.20060301
Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis 62(10):923–930
Pacault-Legendre V, Anract P, Mathieu M, Courpied JP (2009) Pain after total hip arthroplasty: a psychiatric point of view. Int Orthop 33(1):65–69. doi:10.1007/s00264-007-0470-2
Biau DJ, Leclerc P, Marmor S, Zeller V, Graff W, Lhotellier L, Leonard P, Mamoudy P (2012) Monitoring the one year postoperative infection rate after primary total hip replacement. Int Orthop 36(6):1155–1161. doi:10.1007/s00264-011-1444-y
Davis KE, Ritter MA, Berend ME, Meding JB (2007) The importance of range of motion after total hip arthroplasty. Clin Orthop Relat Res 465:180–184. doi:10.1097/BLO.0b013e31815c5a64
Kirmit L, Karatosun V, Unver B, Bakirhan S, Sen A, Gocen Z (2005) The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil 19(6):659–661
Acknowledgments
We thank L. McComiskie and W. Addison (Audit nurses, Fife Acute Hospitals NHS Trust), J. MacDonald (Physiotherapist) and A. Simpson (Database manager, Fife Acute Hospitals NHS Trust) for their help in this study. We acknowledge the consultants whose patients were included in this study: T. Ian, S. Brown, Ivan J. Brenkel, R. Buxton, T. Dougal, R. Marks and I. Weir. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Watson, B.S., Jenkins, P.J. & Ballantyne, J.A. The natural history of unexplained early poor function following total hip replacement. International Orthopaedics (SICOT) 38, 33–37 (2014). https://doi.org/10.1007/s00264-013-2099-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-013-2099-7