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Mental component scores declined following revision THA
Although physical components improved during 2-year follow-up, mental components declined.
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Patients who underwent revision total hip arthroplasty with Stryker Orthopedics' modular neck implant experienced improvement in pain and function, while SF-12 mental component scores declined during 2-year follow-up, according to study results.
“Patients have to be counseled that there are functional improvements, but the mental component is an issue,” Geoffrey H. Westrich, MD, professor of clinical orthopedic surgery, director of research for the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery and attending orthopedic surgeon at Weill Medical College of Cornell University, told Orthopedics Today. “Patients need to know that even 2 years after the surgery, there is an emotional aspect to this that surgery cannot fix.”
Rejuvenate revisions
Westrich and his colleagues collected WOMAC and SF-12 physical and mental component scores preoperatively and at 1-year and 2-years postoperatively for 92 patients (63% women) who underwent revision total hip arthroplasty (THA) with the Rejuvenate modular neck (Stryker Orthopedics) between July 2011 and April 2014.
“What this study showed was that the complication rates were relatively low because we ended up having a 13% complication rate for this, but when you look at the actual complications, we had eight greater trochanteric fractures, one intraoperative fracture, two dislocations, one early loosening [and] one infection,” Westrich said. “Sixty-six percent of patients with a complication required reoperation, so two-thirds of the patients who had a complication required further surgery.”
Researchers found a significant time effect on WOMAC pain score, WOMAC total score, SF-12 mental component score and physical component score, but no significant change in WOMAC function and stiffness scores, University of California Los Angeles activity score, modified Harris Hip score and Harris Hip score during follow-up. According to pairwise comparisons, preoperative WOMAC pain scores significantly improved at 1 year and 2 years. Similarly, total WOMAC scores significantly improved from preoperative values to 2-year values, but not from preoperative values to 1-year values, according to results. While researchers found a significant improvement in SF-12 physical component scores from preoperative values to 1-year and 2-year values, SF-12 mental component scores significantly worsened during the same time frames.
Control group comparison
In a comparison with a control group of 72 patients who underwent non-Rejuvenate revision THA between 2007 and 2012, results showed significantly higher WOMAC pain, stiffness and function scores at baseline in Rejuvenate THA patients vs. the control cohort, but no difference at 2 years. The Rejuvenate revision group also experienced better SF-12 physical health composite scale scores at baseline and at 2 years, according to results. Researchers noted no difference at baseline in SF-12 mental health component scale scores between the two groups. However, the Rejuvenate revision group experienced significantly worse SF-12 mental health component scale scores at 2 years.
“In general, there is definitely some psychological trauma that goes along with having to have your hip revised, and these patients obviously reflected that in their outcomes,” Westrich said. – by Casey Tingle
- Reference:
- Barlow BT, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2015.10.041.
- For more information:
- Geoffrey H. Westrich, MD, can be reached at Hospital for Special Surgery, 535 East 70th St., New York, NY 10021; email: westrichg@hss.edu.
Disclosure: Westrich reports he is a consultant for Stryker Orthopedics.