van Beers L1, Klaassen AD2, Rigters J3, van Rooijen DE4, Gillebaard S5, Willigenburg NW2, Poolman RW2
1OLVG, Orthopaedics and Physical Therapy, Amsterdam, Netherlands, 2OLVG, Orthopaedics, Amsterdam, Netherlands, 3Link, Orthopaedics, Schiedam, Netherlands, 4OLVG, Research and Epidemiology, Amsterdam, Netherlands, 5OLVG, Radiology, Amsterdam, Netherlands
Background: Osteoarthritis (OA) of the hip is a common disease with relatively young patients. The prevalence of OA is increasing rapidly and is expected to increase further in the future. Total hip arthroplasty (THA) is a frequently performed procedure and while this procedure is often successful, about 30% of patients report limitations in physical functioning two years after surgery. This study aims to define which baseline characteristics that have reported associations with functional outcome are important predictors of physical function in patients who underwent THA.
Purpose: The purpose of this study is to identify baseline characteristics which are predictors for post-operative physical functioning in patients who underwent THA. These predictors can improve pre-operative counselling, management of patients' expectations and identify a group of patients who might benefit from close pre- and postoperative monitoring.
Methods: We first performed a systematic literature review to identify patient characteristics with known or suspected associations with physical function after THA. Then, we used multivariate linear regression with backward selection to assess which of these pre-operative characteristics actually predicted physical function in our population of 150 patients who participated in a multicenter RCT. Physical function was quantified as Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS) scores at one year follow up.
Results: The systematic review resulted in strong evidence for BMI, age, comorbidity, mental health and pre-operative physical function as predictors for post-operative physical function. No differences in HOOS-PS scores were observed between randomization groups (Zweimuller vs. CFP stem), so the model was built for the complete study population. The strongest predictors in the study population were mental health (p=0.152), pulmonary comorbidity (p=0.091), and pre-operative physical functioning (p 0.001). Specifically, functional outcome was better in patients with better HOOS-PS and RAND-36 mental component scores, and without pulmonary comorbidity.
Conclusion(s): Based on both literature and the clinical prediction model, mental health, pulmonary comorbidity and pre-operative physical functioning were important predictors of physical functioning in patients 1 year after a THA. These findings are valuable for managing patient expectations and improving functional outcome after THA.
Implications: These results suggest that patients who are at risk for a less favourable functional outcome can be identified. These patients might benefit from additional care by a physical therapist or another caregiver to enhance pre-operative function, overall strength and coping strategies in case of co-morbidity. Furthermore these patients could be trained and monitored more frequently postoperatively. Future studies are needed to determine the (cost-)effectiveness of such interventions.
Keywords: Total hip arthroplasty, Prediction model, Physical functioning
Funding acknowledgements: Link Nederland, Schiedam, The Netherlands
OLVG research foundation
Purpose: The purpose of this study is to identify baseline characteristics which are predictors for post-operative physical functioning in patients who underwent THA. These predictors can improve pre-operative counselling, management of patients' expectations and identify a group of patients who might benefit from close pre- and postoperative monitoring.
Methods: We first performed a systematic literature review to identify patient characteristics with known or suspected associations with physical function after THA. Then, we used multivariate linear regression with backward selection to assess which of these pre-operative characteristics actually predicted physical function in our population of 150 patients who participated in a multicenter RCT. Physical function was quantified as Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS) scores at one year follow up.
Results: The systematic review resulted in strong evidence for BMI, age, comorbidity, mental health and pre-operative physical function as predictors for post-operative physical function. No differences in HOOS-PS scores were observed between randomization groups (Zweimuller vs. CFP stem), so the model was built for the complete study population. The strongest predictors in the study population were mental health (p=0.152), pulmonary comorbidity (p=0.091), and pre-operative physical functioning (p 0.001). Specifically, functional outcome was better in patients with better HOOS-PS and RAND-36 mental component scores, and without pulmonary comorbidity.
Conclusion(s): Based on both literature and the clinical prediction model, mental health, pulmonary comorbidity and pre-operative physical functioning were important predictors of physical functioning in patients 1 year after a THA. These findings are valuable for managing patient expectations and improving functional outcome after THA.
Implications: These results suggest that patients who are at risk for a less favourable functional outcome can be identified. These patients might benefit from additional care by a physical therapist or another caregiver to enhance pre-operative function, overall strength and coping strategies in case of co-morbidity. Furthermore these patients could be trained and monitored more frequently postoperatively. Future studies are needed to determine the (cost-)effectiveness of such interventions.
Keywords: Total hip arthroplasty, Prediction model, Physical functioning
Funding acknowledgements: Link Nederland, Schiedam, The Netherlands
OLVG research foundation
Topic: Orthopaedics; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: OLVG
Ethics committee: VCMO Nieuwegein
Ethics number: NL21637.100.08
All authors, affiliations and abstracts have been published as submitted.
