Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial
Abstract
:1. Purpose
Aim of the Study
2. Patients and Methods
2.1. Study Design
2.2. Study Population
2.3. Comprehensive Geriatric Assessment and Follow-Up
2.4. Operation and Postoperative Care
2.5. Data Analyses
3. Results
3.1. Study Population and Preoperative Comprehensive Geriatric Assessment
3.2. Functional Outcome (WOMAC Score)
3.3. Health-Related Quality of Life (EQ-5D-5L)
3.4. Secondary Outcome
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Demographic Data (n = 101) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Parameters | Mean ± SD | Range | ||||||||||
Age (years) | 78.1 ± 4.9 | 70–89 | ||||||||||
Sex (male:female) | 36:65 (35.6%:64.4%) | |||||||||||
weight (kg) | 78 ± 14.8 | 45–120 | ||||||||||
height (cm) | 165.4 ± 0.1 | 147–188 | ||||||||||
Body mass index (BMI) | 28.5 ± 5.1 | 18–48 | ||||||||||
Obesity level (0–5) | 0 | 1 | 2 | 3 | 4 | 5 | ||||||
1 (1%) | 29 (26%) | 36 (26%) | 26 (19%) | 6 (4%) | 3 (2%) | |||||||
Preoperative comprehensive geriatric assessment (CGA) | ||||||||||||
Level of care (0–3) | 0 | 1 | 2 | 3 | ||||||||
87 (86%) | 4 (4%) | 8 (8%) | 2 (2%) | |||||||||
Preexisting medication (number) | 7.4 ± 4.0 | 1–21 | ||||||||||
Comorbidities (number) | 7.2 ± 3.3 | 1–22 | ||||||||||
Charlson Comorbidity Index (CCI) | 5.4 ± 2.0 | 3–14 | ||||||||||
Mini Nutritional Risk Screening (NRS) | 1–3 | 4 | ||||||||||
96 (95%) | 5 (5%) | |||||||||||
Barthel Index preoperatively | 93 ± 11.1 | 30–100 | ||||||||||
Lawton and Brody Instrumental Activities of Daily Living Scale (IADL) | 6.7 ± 1.8 | 0–8 | ||||||||||
Fried Frailty Index | 2.4 ± 1.2 | 0–4 | ||||||||||
Mini Mental Status Test (MMST) | 26.9 ± 2.8 | 10–30 | ||||||||||
Geriatric Depression Scale (GDS) | 3.3 ± 2.9 | 0–12 | ||||||||||
Short Physical Performance Battery (SPPB) | 7.1 ± 2.8 | 1–12 | ||||||||||
Peri- and postoperative parameters | ||||||||||||
Operated side (right:left) | 50:51 (49.5%:50.5%) | |||||||||||
Duration of surgery (min) | 64.2 ± 17.2 | 34–126 | ||||||||||
Duration of hospitalization (d) | 7.6 ± 2.4 | 7–29 | ||||||||||
Prolongated hospitalization for medical reasons (d) | (n = 11) 0.5 ± 2.4 | 0–22 | ||||||||||
Prolongated hospitalization for organizational reasons (d) | (n = 9) 0.2 ± 0.8 | 0–7 | ||||||||||
Prolongated hospitalization for requirements of health insurance (d) | (n = 1) 0.02 ± 0.2 | 0–2 | ||||||||||
Transfer to another hospital due to medical reasons (cases) | (n = 1) 0.01 ± 0.1 | 0–1 | ||||||||||
Duration of re-hospitalization (d) | (n = 9) 1.1 ± 4.1 | 0–28 |
WOMAC (n = 101) | Statistical Difference (p-Value) | ||||
---|---|---|---|---|---|
(Mean ± SD) | t0 vs. T1 | t0 vs. t2 | t1 vs. t2 | ||
Pain—walking in the plain (0–4) | PRE-OP | 2.8 ± 0.8 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 0.9 ± 0.8 | ||||
3 m POST-OP | 0.5 ± 0.7 | ||||
Pain—descending stairs (0–4) | PRE-OP | 2.9 ± 0.9 | <0.001 | <0.001 | 0.001 |
4–6 w POST-OP | 0.9 ± 0.9 | ||||
3 m POST-OP | 0.6 ± 0.8 | ||||
Pain—sleeping (0–4) | PRE-OP | 2.0 ± 1.2 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 0.8 ± 0.7 | ||||
3 m POST-OP | 0.4 ± 0.7 | ||||
Pain—sitting/laying (0–4) | PRE-OP | 2.1 ± 1.1 | <0.001 | <0.001 | 0.001 |
4–6 w POST-OP | 0.8 ± 0.7 | ||||
3 m POST-OP | 0.5 ± 0.8 | ||||
Pain—standing upright (0–4) | PRE-OP | 2.4 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 0.8 ± 0.8 | ||||
3 m POST-OP | 0.5 ± 0.8 | ||||
Pain—need for medication (0–4) | PRE-OP | 2.0 ± 1.4 | 0.99 | <0.001 | <0.001 |
4–6 w POST-OP | 2.0 ± 0.9 | ||||
3 m POST-OP | 0.5 ± 0.8 | ||||
Stiffness—morning (0–4) | PRE-OP | 2.5 ± 1.1 | <0.001 | <0.001 | 0.002 |
4–6 w POST-OP | 1.2 ± 0.9 | ||||
3 m POST-OP | 0.9 ± 0.9 | ||||
Stiffness—during the course of day (0–4) | PRE-OP | 2.5 ± 1.0 | <0.001 | <0.001 | 0.09 |
4–6 w POST-OP | 1.0 ± 0.8 | ||||
3 m POST-OP | 0.8 ± 0.8 | ||||
Problems—descending stairs (0–4) | PRE-OP | 2.6 ± 1.1 | <0.001 | <0.001 | 0.003 |
4–6 w POST-OP | 1.0 ± 1.0 | ||||
3 m POST-OP | 0.6 ± 0.9 | ||||
Problems—climbing stairs (0–4) | PRE-OP | 2.8 ± 0.9 | <0.001 | <0.001 | 0.005 |
4–6 w POST-OP | 1.1 ± 1.0 | ||||
3 m POST-OP | 0.7 ± 0.9 | ||||
Problems—getting up from chair (0–4) | PRE-OP | 2.8 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.0 ± 0.9 | ||||
3 m POST-OP | 0.6 ± 0.8 | ||||
Problems—standing (0–4) | PRE-OP | 2.3 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.0 ± 0.8 | ||||
3 m POST-OP | 0.5 ± 0.8 | ||||
Problems—bending over (0–4) | PRE-OP | 2.8 ± 1.1 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.8 ± 1.3 | ||||
3 m POST-OP | 1.1 ± 1.1 | ||||
Problems—walking in plain (0–4) | PRE-OP | 2.5 ± 0.8 | <0.001 | <0.001 | 0.12 |
4–6 w POST-OP | 0.6 ± 0.7 | ||||
3 m POST-OP | 0.4 ± 0.7 | ||||
Problems—getting in/out of car (0–4) | PRE-OP | 2.9 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.5 ± 1.0 | ||||
3 m POST-OP | 0.8 ± 0.9 | ||||
Problems—shopping (0–4) | PRE-OP | 2.6 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.3 ± 1.2 | ||||
3 m POST-OP | 0.6 ± 0.9 | ||||
Problems—putting socks on (0–4) | PRE-OP | 3.0 ± 1.1 | <0.001 | <0.001 | 0.003 |
4–6 w POST-OP | 1.7 ± 1.3 | ||||
3 m POST-OP | 1.2 ± 1.1 | ||||
Problems—getting up from bed (0–4) | PRE-OP | 2.4 ± 1.0 | <0.001 | <0.001 | 0.003 |
4–6 w POST-OP | 1.0 ± 0.9 | ||||
3 m POST-OP | 0.7 ± 0.8 | ||||
Problems—putting socks off (0–4) | PRE-OP | 2.8 ± 1.2 | <0.001 | <0.001 | 0.004 |
4–6 w POST-OP | 1.3 ± 1.2 | ||||
3 m POST-OP | 0.8 ± 1.0 | ||||
Problems—laying in bed (0–4) | PRE-OP | 2.0 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 0.7 ± 0.8 | ||||
3 m POST-OP | 0.3 ± 0.7 | ||||
Problems—getting in/out of shower/bathtub (0–4) | PRE-OP | 2.5 ± 1.4 | <0.001 | <0.001 | 0.03 |
4–6 w POST-OP | 0.9 ± 1.1 | ||||
3 m POST-OP | 0.6 ± 0.9 | ||||
Problems—sitting (0–4) | PRE-OP | 1.9 ± 1.1 | <0.001 | <0.001 | 0.03 |
4–6 w POST-OP | 0.6 ± 0.7 | ||||
3 m POST-OP | 0.4 ± 0.6 | ||||
Problems—getting of toilet (0–4) | PRE-OP | 2.3 ± 1.0 | <0.001 | <0.001 | 0.02 |
4–6 w POST-OP | 0.7 ± 0.8 | ||||
3 m POST-OP | 0.5 ± 0.7 | ||||
Problems—doing heavy housework (0–4) | PRE-OP | 3.0 ± 1.0 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 2.1 ± 1.3 | ||||
3 m POST-OP | 1.3 ± 1.2 | ||||
Problems—doing light housework (0–4) | PRE-OP | 2.2 ± 0.9 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 1.0 ± 1.0 | ||||
3 m POST-OP | 0.5 ± 0.9 | ||||
Total result WOMAC (0–100) | PRE-OP | 62.6 ± 18.6 | <0.001 | <0.001 | <0.001 |
4–6 w POST-OP | 27.1 ± 16.1 | ||||
3 m POST-OP | 16.2 ± 15.2 |
EQ-5D-5L (n = 101) | Statistical Difference (p-Value) | ||||
---|---|---|---|---|---|
(Mean ± SD) | t0 vs. t1 | t0 vs. t2 | t1 vs. t2 | ||
Mobility (1–5) | PRE-OP | 3.5 ± 0.8 | <0.001 | <0.001 | 0.99 |
4–6 w POST-OP | 1.7 ± 0.8 | ||||
3 m POST-OP | 1.7 ± 0.9 | ||||
Self-supply (1–5) | PRE-OP | 2.1 ± 1.1 | 0.005 | <0.001 | 0.06 |
4–6 w POST-OP | 1.7 ± 1.0 | ||||
3 m POST-OP | 1.5 ± 0.8 | ||||
General tasks (1–5) | PRE-OP | 2.9 ± 1.2 | <0.001 | <0.001 | 0.01 |
4–6 w POST-OP | 2.0 ± 1.0 | ||||
3 m POST-OP | 1.7 ± 0.9 | ||||
Pain (1–5) | PRE-OP | 3.7 ± 0.8 | <0.001 | <0.001 | 0.35 |
4–6 w POST-OP | 2.0 ± 0.9 | ||||
3 m POST-OP | 1.9 ± 0.9 | ||||
Anxiety (1–5) | PRE-OP | 1.5 ± 0.8 | 0.004 | <0.001 | 0.64 |
4–6 w POST-OP | 1.1 ± 0.3 | ||||
3 m POST-OP | 1.4 ± 0.7 | ||||
Total result EQ-5D-5L | PRE-OP | 37.510 ± 855 | <0.001 | <0.001 | 0.99 |
4–6 w POST-OP | 19.363 ± 896 | ||||
3 m POST-OP | 18.729 ± 955 | ||||
Overall health (0–100) | PRE-OP | 48.4 ± 21.1 | <0.001 | <0.001 | 0.54 |
4–6 w POST-OP | 68.7 ± 19.3 | ||||
3 m POST-OP | 72.8 ± 16.5 |
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Reinhard, J.; Michalk, K.; Schiegl, J.S.; Pagano, S.; Grifka, J.; Maderbacher, G.; Meyer, M.; Kappenschneider, T. Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial. J. Clin. Med. 2024, 13, 2693. https://doi.org/10.3390/jcm13092693
Reinhard J, Michalk K, Schiegl JS, Pagano S, Grifka J, Maderbacher G, Meyer M, Kappenschneider T. Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial. Journal of Clinical Medicine. 2024; 13(9):2693. https://doi.org/10.3390/jcm13092693
Chicago/Turabian StyleReinhard, Jan, Katrin Michalk, Julia Sabrina Schiegl, Stefano Pagano, Joachim Grifka, Günther Maderbacher, Matthias Meyer, and Tobias Kappenschneider. 2024. "Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial" Journal of Clinical Medicine 13, no. 9: 2693. https://doi.org/10.3390/jcm13092693
APA StyleReinhard, J., Michalk, K., Schiegl, J. S., Pagano, S., Grifka, J., Maderbacher, G., Meyer, M., & Kappenschneider, T. (2024). Impressive Short-Term Improvement in Functional Outcome and Quality of Life after Primary Total Hip Arthroplasty (THA) in the Orthogeriatric Patient in a Prospective Monocentric Trial. Journal of Clinical Medicine, 13(9), 2693. https://doi.org/10.3390/jcm13092693