A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty

Judge, Andy, Javaid, M. Kassim, Arden, Nigel K., Cushnaghan, Janet, Reading, Isabel, Croft, Peter, Dieppe, Paul A. and Cooper, Cyrus (2012) A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty. Arthritis & Rheumatism, 64 (6), 881-889. (doi:10.1002/acr.21594). (PMID:22232080)

Abstract

Objective: develop a clinical risk prediction tool to identify patients most likely to experiencelong-term clinically meaningful functional improvement following total hip arthroplasty (THA).

Methods: we studied 282 patients from 2 English health districts (Portsmouth and North Staffordshire), age =45 years receiving THA for primary osteoarthritis. Baseline data were collected by interview and examination, on age, sex, comorbidity, body mass index (BMI), functional status (SF-36), and preoperative radiographic severity. The outcome was a clinically significant (30-point) improvement in SF-36 physical function assessed ?8-years after THA. Logistic regression modelling was used to identify predictors of functional improvement.

Results: improvement in physical functioning was less likely in those with better pre-operative functioning[OR 0.73 95%CI (0.60, 0.89)], in older people[0.94 (0.90, 0.98)], women[0.37 (0.19, 0.72)], a previous hip injury[0.14 (0.03, 0.74)], and greater number of painful joint sites[0.61 (0.46, 0.80)]. Patients with worse radiographic grades were most likely to improve[2.15 (1.17, 3.93)]. We found no influence of BMI or patient co-morbidity on functional outcome. Predictors of good outcome were the same as those of bad outcomes, acting in the opposite direction. A clinical risk prediction tool was developed to identify patients who are most likely to receive functional improvement following THA.

Conclusion: this prediction tool has the potential to inform healthcare professionals and patients about functional improvement following THA (as distinct from driving rationing or commissioning decisions on who should have surgery); itrequires introduction into clinical practice under research conditions to investigate its impact on decisions made by patients and clinicians

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Contributors

Author: Isabel Reading

Author: Cyrus Cooper

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