Skip to main content
Health Services Research logoLink to Health Services Research
. 1996 Dec;31(5):623–638.

Patient-related risk factors that predict poor outcome after total hip replacement.

C H MacWilliam 1, M U Yood 1, J J Verner 1, B D McCarthy 1, R E Ward 1
PMCID: PMC1070145  PMID: 8943994

Abstract

OBJECTIVE: To identify factors associated with poor outcome after total hip replacement (THR) surgery. DATA SOURCES: This article is the first to present results from the American Medical Group Association (AMGA) THR consortium. STUDY DESIGN: The outcomes evaluated were pain and physical function. Eight patient risk factors were evaluated. These included the age, sex, race, marital status, and education of the patient; whether the patient had polyarticular disease or other comorbid conditions; and the patient's preoperative pain and physical function score. DATA COLLECTION: Data were collected from patients using AMGA-approved, self-administered questionnaires preoperatively and at six weeks, three months, six months, one year, and two years postoperatively. PRINCIPAL FINDINGS: Of the patient risk factors studied, race, education, number of comorbid conditions, and preoperative Health Status Questionnaire (HSQ) score were found to be associated with poor outcome. These risk factors were found to have an effect on both pain and physical function at six months postoperatively. Patients with higher preoperative scores were found to have higher postoperative scores, but substantially fewer of these patients received any benefit from their surgery. For each 10-point increase in preoperative score, patients could expect at least a 6-point decrease in postoperative improvement. CONCLUSIONS: Our study indicates that preoperative status is an important predictor of outcome for THR.

Full text

PDF
638

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bell N. H., Greene A., Epstein S., Oexmann M. J., Shaw S., Shary J. Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest. 1985 Aug;76(2):470–473. doi: 10.1172/JCI111995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Black N., Petticrew M., Ginzler M., Flood A., Smith J., Williams G., Davies J., Doll H., McPherson K. Do doctors and patients agree? Views of the outcome of transurethral resection of the prostate. Int J Technol Assess Health Care. 1991;7(4):533–544. doi: 10.1017/s0266462300007091. [DOI] [PubMed] [Google Scholar]
  3. Charlson M. E., Pompei P., Ales K. L., MacKenzie C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8. [DOI] [PubMed] [Google Scholar]
  4. Cleary P. D., Reilly D. T., Greenfield S., Mulley A. G., Wexler L., Frankel F., McNeil B. J. Using patient reports to assess health-related quality of life after total hip replacement. Qual Life Res. 1993 Feb;2(1):3–11. doi: 10.1007/BF00642884. [DOI] [PubMed] [Google Scholar]
  5. Cummings S. R., Phillips S. L., Wheat M. E., Black D., Goosby E., Wlodarczyk D., Trafton P., Jergesen H., Winograd C. H., Hulley S. B. Recovery of function after hip fracture. The role of social supports. J Am Geriatr Soc. 1988 Sep;36(9):801–806. doi: 10.1111/j.1532-5415.1988.tb04263.x. [DOI] [PubMed] [Google Scholar]
  6. Ellwood P. M. Shattuck lecture--outcomes management. A technology of patient experience. N Engl J Med. 1988 Jun 9;318(23):1549–1556. doi: 10.1056/NEJM198806093182327. [DOI] [PubMed] [Google Scholar]
  7. Farmer M. E., White L. R., Brody J. A., Bailey K. R. Race and sex differences in hip fracture incidence. Am J Public Health. 1984 Dec;74(12):1374–1380. doi: 10.2105/ajph.74.12.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Felson D. T., Zhang Y., Hannan M. T., Kiel D. P., Wilson P. W., Anderson J. J. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med. 1993 Oct 14;329(16):1141–1146. doi: 10.1056/NEJM199310143291601. [DOI] [PubMed] [Google Scholar]
  9. Friedman B., Elixhauser A. Increased use of an expensive, elective procedure: total hip replacements in the 1980s. Med Care. 1993 Jul;31(7):581–599. doi: 10.1097/00005650-199307000-00002. [DOI] [PubMed] [Google Scholar]
  10. Gartland J. J. Orthopaedic clinical research. Deficiencies in experimental design and determinations of outcome. J Bone Joint Surg Am. 1988 Oct;70(9):1357–1364. [PubMed] [Google Scholar]
  11. Gogia P. P., Christensen C. M., Schmidt C. Total hip replacement in patients with osteoarthritis of the hip: improvement in pain and functional status. Orthopedics. 1994 Feb;17(2):145–150. doi: 10.3928/0147-7447-19940201-10. [DOI] [PubMed] [Google Scholar]
  12. Greenfield S., Apolone G., McNeil B. J., Cleary P. D. The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Med Care. 1993 Feb;31(2):141–154. doi: 10.1097/00005650-199302000-00005. [DOI] [PubMed] [Google Scholar]
  13. Haan M., Kaplan G. A., Camacho T. Poverty and health. Prospective evidence from the Alameda County Study. Am J Epidemiol. 1987 Jun;125(6):989–998. doi: 10.1093/oxfordjournals.aje.a114637. [DOI] [PubMed] [Google Scholar]
  14. Harris W. H., Sledge C. B. Total hip and total knee replacement (1). N Engl J Med. 1990 Sep 13;323(11):725–731. doi: 10.1056/NEJM199009133231106. [DOI] [PubMed] [Google Scholar]
  15. Kirwan J. R., Currey H. L., Freeman M. A., Snow S., Young P. J. Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol. 1994 Apr;33(4):357–360. doi: 10.1093/rheumatology/33.4.357. [DOI] [PubMed] [Google Scholar]
  16. Liang M. H., Cullen K. E., Larson M. G., Thompson M. S., Schwartz J. A., Fossel A. H., Roberts W. N., Sledge C. B. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986 Aug;29(8):937–943. doi: 10.1002/art.1780290801. [DOI] [PubMed] [Google Scholar]
  17. Liel Y., Edwards J., Shary J., Spicer K. M., Gordon L., Bell N. H. The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women. J Clin Endocrinol Metab. 1988 Jun;66(6):1247–1250. doi: 10.1210/jcem-66-6-1247. [DOI] [PubMed] [Google Scholar]
  18. Matthews K. A., Kelsey S. F., Meilahn E. N., Kuller L. H., Wing R. R. Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol. 1989 Jun;129(6):1132–1144. doi: 10.1093/oxfordjournals.aje.a115235. [DOI] [PubMed] [Google Scholar]
  19. Osborne N. G., Feit M. D. The use of race in medical research. JAMA. 1992 Jan 8;267(2):275–279. [PubMed] [Google Scholar]
  20. Petersen V. S., Solgaard S., Simonsen B. Total hip replacement in patients aged 80 years and older. J Am Geriatr Soc. 1989 Mar;37(3):219–222. doi: 10.1111/j.1532-5415.1989.tb06810.x. [DOI] [PubMed] [Google Scholar]
  21. Selker H. P., Griffith J. L., D'Agostino R. B. A time-insensitive predictive instrument for acute hospital mortality due to congestive heart failure: development, testing, and use for comparing hospitals: a multicenter study. Med Care. 1994 Oct;32(10):1040–1052. doi: 10.1097/00005650-199410000-00005. [DOI] [PubMed] [Google Scholar]
  22. Sharkness C. M., Hamburger S., Moore R. M., Jr, Kaczmarek R. G. Prevalence of artificial hip implants and use of health services by recipients. Public Health Rep. 1993 Jan-Feb;108(1):70–75. [PMC free article] [PubMed] [Google Scholar]
  23. Stoskopf C., Horn S. D. Predicting length of stay for patients with psychoses. Health Serv Res. 1992 Feb;26(6):743–766. [PMC free article] [PubMed] [Google Scholar]
  24. Thorsen H., McKenna S. P., Gottschalck L. The Danish version of the Nottingham Health Profile: its adaptation and reliability. Scand J Prim Health Care. 1993 Jun;11(2):124–129. doi: 10.3109/02813439308994914. [DOI] [PubMed] [Google Scholar]
  25. Wiklund I., Romanus B. A comparison of quality of life before and after arthroplasty in patients who had arthrosis of the hip joint. J Bone Joint Surg Am. 1991 Jun;73(5):765–769. [PubMed] [Google Scholar]
  26. Winkleby M. A., Jatulis D. E., Frank E., Fortmann S. P. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992 Jun;82(6):816–820. doi: 10.2105/ajph.82.6.816. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wright J. G., Rudicel S., Feinstein A. R. Ask patients what they want. Evaluation of individual complaints before total hip replacement. J Bone Joint Surg Br. 1994 Mar;76(2):229–234. [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES