THA patients’ mental health, age and gender found to affect self-perceived outcomes

With pain and reduced health-related quality of life being the main reasons most people undergo total hip arthroplasty, Swedish researchers found not all patients who have this surgery in their country improve based on the patient-reported outcome measures.

At 1-year minimum follow-up, satisfactory results with total hip arthroplasty (THA) greatly depended on mental health, age and gender, investigator Ola Rolfson, MD, PhD, of the University of Gothenburg, in Gothenburg, Sweden, told Orthopaedics Today Europe.

Rolfson, who presented the research at the 2011 Orthopaedic Research Society Annual Meeting in Long Beach, Calif., USA, said senior investigator Göran Garellick, MD, PhD, will present updated results, including information on the health economics of THA, at the 2011 EFORT Congress in Copenhagen in June.

The use of patient-reported outcome measures (PROMs) in conjunction with the Swedish Total Hip Arthroplasty Register began in 2002; however, the U.K. recently began requiring these types of measures be used following THA and total knee arthroplasty, according to the study.

Focus on non-responders

Based on outcomes of the Swedish THA PROMs program that Rolfson and colleagues analyzed, most of the 34,960 THA patients who completed the EuroQual-5D (EQ-5D) instrument, Charnley functional assessment and Visual Analog Scale for pain 1 year after surgery had great improvement in health-related quality of life, Rolfson said.

“They have a remarkable pain reduction and they are highly satisfied, but there is an important minority that we should focus on that, after 1 year, does not respond satisfactorily,” he said.

Discussing the “minority” results, Rolfson said those with severe anxiety based on the EQ-5D had less pain reduction and satisfaction at 1 year postoperatively. “That generates a hypothesis that people with anxiety might be affected by the hip disease differently than patients who do not have this kind of problem,” he said, urging clinicians to beware of their patients’ mental health when recommending THA.

Mental health, comorbidities

Individuals with greater or increased comorbidities based on the Charnley functional assessment also had poorer outcomes than the rest of the cohort, which might be explained by the fact it is harder in this population to clearly tell if THA is indicated or not, Rolfson said.

When researchers compared this large THA population to one that was age- and gender-matched, their findings were contrary to reports saying that women have worse outcomes than men after THA.

“Actually, the improvement for women seemed to be greater than for men,” Rolfson said, noting that it is quite likely this finding may be due to differences in how women and men report their hip disease on the EQ-5D instrument.

Satisfactory THA outcomes were also age-dependent with the youngest and oldest patients’ results falling outside the normal range, Rolfson added.

With these patient-reported THA data, we showed “it is really possible in an entire population to start in a few years and get [the program] running with a good response rate” of 90% at 1 year, he said. – by Susan M. Rapp

References:

• Rolfson O. Patient-reported outcome measure and health-economic aspects of total hip arthroplasty – a study of the Swedish Hip Arthroplasty Register. Thesis. University of Gothenburg, 2010. Available at http://hdl.handle.net/2077/23722
• Rolfson O, et al. Patient-reported outcomes in the Swedish total hip arthroplasty population. Poster #963. Presented at the 2011 Orthopaedic Research Society Annual Meeting. Jan. 13-16, 2011. Long Beach, Calif., USA.

• Ola Rolfson, MD, PhD, can be reached in the Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; +46-705226386; e-mail: ola.rolfson@vgregion.se.
• Disclosure: Rolfson has no relevant financial disclosures.

Anyone performing any type of surgical procedure knows that there is a difference between what the surgeon and the patient perceive as a good or poor final result.

This mastodontic study on the Swedish Registry has analyzed a large number of patients undergoing total hip arthroplasty (THA) according to a self-administered 10-item questionnaire. The idea was quite interesting, the numbers impressive (34,960 THAs), as well as the statistical analysis. The figures have been matched in any possible way.

Which were the outstanding conclusions of this enormous effort? Patients are in large part quite satisfied with the treatment. Those patients who are showing the worst outcomes are the severely depressed and those with important comorbidities.

The mountain has given birth to a little mouse. I think that we should start to reconsider the amount of money that we spend on statistical research.

—Roberto Binazzi, MD
Chairman of the Department of Orthopaedics and Hip Surgery
University of Bologna
Villa Erbosa Hospital
Bologna, Italy

Disclosure: He has no relevant financial disclosures.