Gajardo Burgos R1, San Martín Correa M1, Saavedra Santiesteban C1, Monrroy Uarac M1, Arteaga San Martín R1, Barría Pailaquilén M1
1Universidad Austral de Chile, School of Kinesiology, Valdivia, Chile
Background: Aging is associated with the presence of degenerative joint diseases, being the first cause of functional deterioration in older adults. One of the health objectives of Chile in the decade 2011-2020 is to improve the health status of the elderly, being a strategy the implementation of an explicit health guarantee (GES in spanish) in which subjects over 64, with hip osteoarthritis and severe functional limitation are beneficiaries of a total hip endoprosthesis surgery for free. The independence level (IL) and functional capacity (FC) seem to be good predictors of the functional results of this surgery.
Purpose: To determine the evolution of postoperative functional capacity and independence level in patients undergoing total hip arthroplasty (THA).
Methods: Longitudinal analytical study. All patients admitted to THA surgery between June 2017 and June 2018 who met the inclusion criteria (n= 57) were evaluated before surgery and followed up monthly until the fourth month to evaluate the IL (Barthel index) and the FC (WOMAC index) over the telephone. The subjects according to IL were divided into independent (100 points) and dependent ( 100 points). In addition, the subjects were classified into two groups according to the mean reference value of WOMAC in, better (B; ≥48) and worse (W; 48). The mean values of Barthel and WOMAC were compared between the groups at one, two and three-four months, using t test. We also compared the mean differences in time within each group and between groups using paired t-test.
Results: We found significant differences in the mean (± SD) of the FC between B and W at month (n=22) (n= 12, 20.08 ± 8.83 vs. n=10, 36.5 ± 7.65, p=0.0002), at two months (n=20) (n=12, 15.42 ± 12.09 vs. n=8, 32.88 ± 23.14, p=0.0397) and the third / fourth month (n=23) (n=12; 11.0 ± 5.74 vs. n=11, 25.82 ± 20.30, p=0.0242). For IL there were no differences between the groups according to the initial condition of independent and dependent. Regarding the variation within each group, no differences were observed for FC between B and W in any of the months of follow-up. While, for IL, significant differences were observed between independent and dependent at month (n=22) (n=9, -5.56 ± 7.68 vs. n=13, 5.39 ± 8.77, p=0.0068), at two months (n=20) (n=9, -1.11 ± 2.21 vs. n=11, 7.27 ± 4.67, p=0.0001) and the third/fourth month (n=23) (n=10, 0.0 ± 0.0 vs. n=13; 10.39 ± 8.77, p=0.0013).
Conclusion(s): The results show that subjects who undergo total hip arthroplasty improve their functional capacity and level of independence. Despite this, subjects who have a worse functional capacity before surgery do not achieve the same results as those who have a better capacity.
Implications: These results allow to project the need of a kinesthetic prehabilitation program to improve this condition, in subjects with greater limitation, also helping to the functional prognosis of the patients, being a contribution to a national health strategy.
Keywords: Total Hip Arthroplasty, Functional capacity, Prognosis
Funding acknowledgements: This research is sponsored by the Vicerrectoría de Investigación, Desarrollo y Creación Artística of the Universidad Austral de Chile.
Purpose: To determine the evolution of postoperative functional capacity and independence level in patients undergoing total hip arthroplasty (THA).
Methods: Longitudinal analytical study. All patients admitted to THA surgery between June 2017 and June 2018 who met the inclusion criteria (n= 57) were evaluated before surgery and followed up monthly until the fourth month to evaluate the IL (Barthel index) and the FC (WOMAC index) over the telephone. The subjects according to IL were divided into independent (100 points) and dependent ( 100 points). In addition, the subjects were classified into two groups according to the mean reference value of WOMAC in, better (B; ≥48) and worse (W; 48). The mean values of Barthel and WOMAC were compared between the groups at one, two and three-four months, using t test. We also compared the mean differences in time within each group and between groups using paired t-test.
Results: We found significant differences in the mean (± SD) of the FC between B and W at month (n=22) (n= 12, 20.08 ± 8.83 vs. n=10, 36.5 ± 7.65, p=0.0002), at two months (n=20) (n=12, 15.42 ± 12.09 vs. n=8, 32.88 ± 23.14, p=0.0397) and the third / fourth month (n=23) (n=12; 11.0 ± 5.74 vs. n=11, 25.82 ± 20.30, p=0.0242). For IL there were no differences between the groups according to the initial condition of independent and dependent. Regarding the variation within each group, no differences were observed for FC between B and W in any of the months of follow-up. While, for IL, significant differences were observed between independent and dependent at month (n=22) (n=9, -5.56 ± 7.68 vs. n=13, 5.39 ± 8.77, p=0.0068), at two months (n=20) (n=9, -1.11 ± 2.21 vs. n=11, 7.27 ± 4.67, p=0.0001) and the third/fourth month (n=23) (n=10, 0.0 ± 0.0 vs. n=13; 10.39 ± 8.77, p=0.0013).
Conclusion(s): The results show that subjects who undergo total hip arthroplasty improve their functional capacity and level of independence. Despite this, subjects who have a worse functional capacity before surgery do not achieve the same results as those who have a better capacity.
Implications: These results allow to project the need of a kinesthetic prehabilitation program to improve this condition, in subjects with greater limitation, also helping to the functional prognosis of the patients, being a contribution to a national health strategy.
Keywords: Total Hip Arthroplasty, Functional capacity, Prognosis
Funding acknowledgements: This research is sponsored by the Vicerrectoría de Investigación, Desarrollo y Creación Artística of the Universidad Austral de Chile.
Topic: Orthopaedics; Musculoskeletal: lower limb; Musculoskeletal
Ethics approval required: Yes
Institution: Servicio de Salud Valdivia
Ethics committee: Comité Ético Científico
Ethics number: 217. 16.05.2017
All authors, affiliations and abstracts have been published as submitted.
