Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Orthopedic Surgery, Sohag University, Sohag, Egypt.
Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
J Arthroplasty. 2024 Sep;39(9S1):S105-S111. doi: 10.1016/j.arth.2024.02.050. Epub 2024 Feb 25.
Previous reports have identified a number of potential predictors of pain and function after total hip arthroplasty (THA). However, the results of these studies were conflicting, and most had a short follow-up after THA. The purpose of this study was to identify factors predictive of pain and function 5 years after THA.
A multicenter cohort of 7,934 primary unilateral THA patients was prospectively enrolled in the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement consortium. Demographic data, comorbidities, and patient-reported outcome measures were collected preoperatively and postoperatively at 5 years, including the Hip Disability and OSteoarthritis Outcome Score (HOOS) pain and activities of daily living (ADL) scores. Multivariate logistic regression models with 95% confidence interval were used to identify independent predictors of pain and function at 5 years.
The patient dissatisfaction percentage was 8.2% at 5 years after THA. The multivariate regression identified the following predictive factors for the HOOS pain score at 5 years: age, educational level, insurance, smoking, race, Charlson Comorbidity Index, back pain severity, number of other lower extremity painful joints, the Knee Injury and Osteoarthritis Outcome Score pain severity of the ipsilateral knee, preoperative Short-Form Health Survey 36-item (SF-36) mental component summary score, and HOOS pain scores. The multivariate regression identified the following predictor factors for HOOS ADL score at 5 years: body mass index, insurance, smoking, race, back pain severity, number of other lower extremity painful joints, Knee Injury and Osteoarthritis Outcome Score pain severity of ipsilateral knee, preop HOOS ADL, and preoperative SF-36 mental component summary score and SF-36 physical component summary score.
Overall, 8.2% of patients were dissatisfied 5 years after primary THA. We have identified a number of factors that predict less improvement in pain and function 5 years after THA. These potentially modifiable factors can be targeted with preoperative patient optimization programs to improve patient outcomes and satisfaction after primary THA. Knowledge of these factors that predict less improvement in pain and function can assist the surgeon and patient during shared decision-making, and in setting appropriate patient expectations preoperatively.
先前的报告已经确定了全髋关节置换术（THA）后疼痛和功能的一些潜在预测因素。然而，这些研究的结果存在冲突，并且大多数在 THA 后随访时间较短。本研究的目的是确定 THA 后 5 年疼痛和功能的预测因素。
Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement 协作组前瞻性纳入了 7934 例初次单侧 THA 患者的多中心队列。收集了术前和术后 5 年的人口统计学数据、合并症和患者报告的结果测量指标，包括髋关节残疾和骨关节炎结局评分（HOOS）疼痛和日常生活活动（ADL）评分。使用 95%置信区间的多变量逻辑回归模型确定 5 年后疼痛和功能的独立预测因素。
THA 后 5 年患者不满意的百分比为 8.2%。多元回归确定了 5 年后 HOOS 疼痛评分的以下预测因素：年龄、教育水平、保险、吸烟、种族、Charlson 合并症指数、腰痛严重程度、其他下肢疼痛关节的数量、同侧膝关节的膝关节损伤和骨关节炎结局评分疼痛严重程度、术前简明健康调查 36 项（SF-36）心理成分综合评分以及 HOOS 疼痛评分。多元回归确定了 5 年后 HOOS-ADL 评分的以下预测因素：体重指数、保险、吸烟、种族、腰痛严重程度、其他下肢疼痛关节的数量、同侧膝关节的膝关节损伤和骨关节炎结局评分疼痛严重程度、术前 HOOS-ADL 以及术前 SF-36 心理成分综合评分和 SF-36 生理成分综合评分。
总体而言，初次 THA 后 5 年，8.2%的患者不满意。我们已经确定了一些因素，这些因素可预测 THA 后 5 年疼痛和功能改善不明显。这些潜在可改变的因素可以通过术前患者优化计划来针对，以改善初次 THA 后的患者结局和满意度。了解这些预测疼痛和功能改善不明显的因素可以帮助外科医生和患者在共同决策期间，并在术前设定适当的患者期望。
