Wang Yuanyuan, Owen Alice, Franks Angus, Ackerman Ilana, Fitzgerald Sharyn M, Liew Susan, Woods Robyn L, Wluka Anita E, McNeil John J, Cicuttini Flavia M
School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.
Alfred Hospital, Melbourne 3004, Australia.
J Clin Med. 2022 Aug 30;11(17):5117. doi: 10.3390/jcm11175117.
Uncertainty remains regarding the benefit of hip replacement in older adults in the context of age-related decline in physical function. This study aimed to examine the effect of hip replacement on functional outcomes and identify factors associated with clinically important improvement in physical function postoperatively in community-dwelling older adults. This cohort study was performed within the ASPREE trial, with 698 participants receiving hip replacement and 677 age- and sex-matched controls without knee or hip replacement during the trial drawn from 16,703 Australian participants aged ≥70 years. Health status (physical and mental component summary [PCS and MCS]) was assessed annually using the SF-12. Participants receiving hip replacement had significantly lower pre- and post-replacement PCS scores compared with controls (p < 0.0001). There was significant improvement in PCS score following hip replacement (mean change 4.9, 95%CI 4.0−5.7) but no change in controls (0.01, 95%CI −0.7−0.7). Following hip replacement, 46.7% of participants experienced clinically important improvement in PCS score, while 15.5% experienced worsened PCS score. Participants experiencing improved postoperative PCS score had significantly lower PCS and higher MCS scores preoperatively. The degree of preoperative physical function impairment was a significant indicator of older people most likely to benefit from hip replacement surgery.
在身体功能出现与年龄相关衰退的情况下，髋关节置换术对老年人的益处仍不明确。本研究旨在探讨髋关节置换术对功能结局的影响，并确定与社区居住的老年人术后身体功能临床重要改善相关的因素。这项队列研究是在ASPREE试验中进行的，从16703名年龄≥70岁的澳大利亚参与者中选取了698名接受髋关节置换术的参与者和677名年龄及性别匹配、在试验期间未进行膝关节或髋关节置换术的对照组。每年使用SF-12评估健康状况（身体和心理成分总结[PCS和MCS]）。与对照组相比，接受髋关节置换术的参与者在置换术前和术后的PCS评分显著更低（p<0.0001）。髋关节置换术后PCS评分有显著改善（平均变化4.9，95%CI 4.0−5.7），而对照组无变化（0.01，95%CI -0.7−0.7）。髋关节置换术后，46.7%的参与者PCS评分有临床重要改善，而15.5%的参与者PCS评分恶化。术后PCS评分改善的参与者术前PCS评分显著更低，MCS评分更高。术前身体功能受损程度是最有可能从髋关节置换手术中获益的老年人的一个重要指标。
