A Clinical Prediction Rule for Predicting the Cane Use at 6 Months After Total Hip Arthroplasty

This study aimed to identify clinical prediction rule (CPR) based on preoperative factors that distinguish between cane use and non-use at 6 months postoperatively in patients with THA.

This study included 186 patients (29 males, 157 females; mean age: 65.3 ± 8.8 years; body mass index (BMI): 24.1 ± 3.8 kg/m²) diagnosed with hip osteoarthritis who underwent initial unilateral THA. Preoperative assessments included age, sex, BMI, preoperative cane use, and the Timed Up and Go Test (TUG) scores, with cane use as the outcome measure evaluated at 6 months postoperatively. Logistic regression analysis was conducted to assess the relationship between the prevalence of cane use at 6 months postoperatively as a dependent variable and 5 preoperative factors as independent variables. Cut-off values for each variable identified through logistic regression analysis were determined using receiver operating characteristic (ROC) curve analysis. A score of 1 was assigned for each variable when the value was worse than the cutoff, and CPR was created by summing the scores of each variable, followed by an evaluation of their diagnostic characteristics.

Thirty-two patients (17.2%) were in the cane group, while 154 patients (82.8%) were in the non-cane group. The variables identified through logistic regression analysis were age, preoperative cane use, and TUG. Based on the cut-off values identified by ROC curve analysis, the criteria for each variable in the CPR to predict cane use at 6 months postoperatively were: age ≥ 65 years, preoperative cane use, and TUG ≥ 9.0 seconds. A total CPR score of 3 (range: 0-3; higher scores indicating worse outcomes) based on 3 factors indicated a 48.8% probability of using a cane at 6 months postoperatively, compared to 8.3% for a total score of 2 or less.

The results of this study suggested that patients who were older, used a cane, and had reduced mobility preoperatively were more likely to require a cane for walking 6 months after THA. 

The CPR, based on the three factors presented in this study, can predict in advance whether a patient will require a cane 6 months after THA surgery. It also aids in planning perioperative physical therapy tailored to the patient's individual characteristics.