 |
|
|
 |
Primary and Revision Hip Arthroplasty: 5-year Outcomes and Influence of Age and Comorbidity
ANNE LÜBBEKE, JEFFREY N. KATZ, THOMAS V. PERNEGER, and PIERRE HOFFMEYER ABSTRACT. Objective. Revision hip arthroplasty is associated with less favorable short and longterm results than primary total hip arthroplasty (THA). We compared quality of life and satisfaction 5 years after the 2 interventions, to determine the influence of patient characteristics on poorer outcomes after revision, and to analyze if their influence differed for primary and for revision arthroplasty. Methods. This was a hospital-based prospective cohort study including patients who underwent primary (n = 435) or revision THA (n = 116). Quality of life was measured by Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Medical Outcomes Study Short Form-12 questionnaire. Satisfaction was evaluated with a visual analog scale. Results. Patients undergoing a revision were older, more often obese, and had more medical and orthopedic comorbidities. Five years after surgery, 349 patients with primary THA and 85 with revisions were available for followup. Unadjusted quality of life and satisfaction were significantly lower after revision (Harris Hip Score 76.7 vs 88.1; WOMAC pain 66.4 vs 73.3; WOMAC function 61.6 vs 70.0; satisfaction 7.7 vs 8.9). Adjustment for patient characteristics revealed that this difference was partly explained by the greater morbidity and older age of patients undergoing revision. The influence of age, comorbidities, and preoperative function on 5-year outcomes did not substantially differ for the 2 intervention groups. However, obesity was associated with a stronger negative effect on revision surgery. Conclusion. Patients and physicians should acknowledge additional risks and consequently lower results associated with revision THA. Better information and medical preparation before surgery may help to improve the success of revision surgery. (First Release Dec 1 2006; J Rheumatol 2007;34:394-400) Key Indexing Terms:
HIP From the Department of Orthopaedic Surgery, Geneva University Hospital, Geneva, Switzerland; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, and Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; and Quality of Care Service, Geneva University Hospital, Geneva, Switzerland. Supported by US National Institutes of Health grants NIH P60 AR47782 and NIH K24 AR02123. A. Lübbeke, MD, MSc, Department of Orthopaedic Surgery, Geneva University Hospitals; J.N. Katz, MD, MS, Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, and Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School; T.V. Perneger, MD, PhD, Quality of Care Service, Geneva University Hospital; P. Hoffmeyer, MD, Department of Orthopaedic Surgery, Geneva University Hospital. Address reprint requests to Dr. A. Lübbeke, Department of Orthopaedic Surgery, Geneva University Hospitals, 24, rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland. E-mail: anne.lubbekewolff@hcuge.ch Accepted for publication September 22, 2006.
|
