Coxe Francesca R, Kahlenberg Cynthia A, Garvey Matthew, Cororaton Agnes, Jerabek Seth A, Mayman David J, Figgie Mark P, Sculco Peter K
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 May;20(2):245-253. doi: 10.1177/15563316231158615. Epub 2023 Mar 17.
Little is known about patients' postoperative week-by-week progress after undergoing posterior approach total hip arthroplasty (THA) with regard to pain, function, return to work, and driving. : We sought to evaluate a large cohort of patients undergoing posterior approach THA with modified posterior hip precautions to better understand the trajectory of recovery. : Patients at a single institution undergoing primary posterior approach THA by fellowship-trained arthroplasty surgeons were prospectively enrolled. Patient functional status and early rehabilitation recovery milestones were evaluated preoperatively and each week postoperatively for 6 weeks. : Of 312 patients who responded to weekly questionnaires, there were varying response rates per question. At 1 week after surgery, 15% (39/256) of respondents had returned to work, increasing to 57% (129/225) at week 6. At 6 weeks, 77% of patients (174/225) had returned to driving; 25% (56/225) were taking pain medication (including prescription opioids or nonsteroidal anti-inflammatory drugs); and 15% (34/225) were using assistive devices (down from 91%, 78%, 56%, 35%, and 27% at weeks 1, 2, 3, 4, and 5, respectively). Average postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement and Lower Extremity Functional Scale scores were significantly higher than preoperative scores. Respondents reported significantly less pain at each week postoperatively than the previous week. : These findings suggest that there may be an expected pathway for recovery after posterior THA using perioperative pain protocols, modified postoperative precautions, and physical therapy protocols to improve patient outcomes after THA, with most patients returning to normal at 4 weeks. Defining the expected recovery timeline may help surgeons in counseling patients preoperatively and guiding their recovery.
对于接受后入路全髋关节置换术（THA）的患者在疼痛、功能、恢复工作和驾驶方面术后逐周的进展情况，我们了解甚少。我们试图评估一大群接受后入路THA并采用改良后髋关节预防措施的患者，以更好地了解恢复轨迹。在一家机构中，由接受过专科培训的关节置换外科医生对接受初次后入路THA的患者进行前瞻性登记。术前以及术后每周对患者的功能状态和早期康复恢复里程碑进行评估，为期6周。在312名回复每周问卷的患者中，每个问题的回复率各不相同。术后1周，15%（39/256）的受访者已恢复工作，到第6周时增至57%（129/225）。在第6周时，77%的患者（174/225）已恢复驾驶；25%（56/225）的患者正在服用止痛药（包括处方阿片类药物或非甾体抗炎药）；15%（34/225）的患者使用辅助器械（分别从第1、2、3、4和5周时的91%、78%、56%、35%和27%下降）。术后平均髋关节功能障碍和骨关节炎关节置换结局评分以及下肢功能量表评分显著高于术前评分。受访者报告术后每周的疼痛明显少于前一周。这些发现表明，使用围手术期疼痛方案、改良的术后预防措施和物理治疗方案，后入路THA术后可能存在预期的恢复途径，以改善THA后的患者结局，大多数患者在4周时恢复正常。确定预期的恢复时间表可能有助于外科医生在术前为患者提供咨询并指导他们的恢复。
