Background/Purpose:

Osteoarthritis (OA) is chronic condition associated with a number of other comorbidities which may affect the 6 month pattern of recovery of total hip arthroplasty (THA).  It is not clearly understood which comorbidities affect 6-month pain relief and functional recovery.  We looked at the pattern of recovery for THA to determine which comorbid conditions had the most impact on the recovery following THA in terms of pain relief and functional improvement.

Methods:

Longitudinal prospective inception cohort of 305 patients receiving elective primary THA  were followed within a month prior to surgery, and then at 1, 3, 6 months after surgery. The outcome measures, hip pain and function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).  Comorbid conditions were extracted from the chart and reported by the patient using a standardized list. Patients who reported conditions also rated the impact of the specific condition on routine activities. Health status was measured using a generic health measure, Health Utilities Index Mark3 (HUI3). The Center for Epidemiologic Studies-Depression (CES-D) was used to screen for depressive symptomology.  Measurements were repeated at each of the follow-up interviews. Linear mixed models were developed for pain and functional recovery of THA to evaluate changes over time while adjusting for covariates.

Results:

The mean age of participants was 65.9 (SD10.1) yrs; 175(57%) were female.  Mean pre-operative WOMAC pain improved from 56.0(SD 16.7) to 10.8 (SD 13.2) over the 6 months (p<0.001).  The mean pre-operative WOMAC function improved from 54.7 (SD 16.4) to 18.7 (SD 12.8) over this time (p<0.001).  At baseline, the mean overall HUI3 score was 0.42 (SD 0.26). At baseline, 101(33%) had low back pain, 80(26%) had chronic respiratory disease, 60 (20%) had depressive symptomology, and 77 (25%) urinary incontinence. After controlling for age, sex, baseline pain and time, depression score (coeff 2.2, p=0.06), low back pain (coeff 2.8, p<0.01), chronic respiratory disease (coeff 4.4, p<0.01) had a deleterious effect on pain relief.  Urinary incontinence (coeff 2.0, p=0.03), after controlling above mentioned variables, affected functional improvement.

Conclusion:

Patients with low back pain, depression and chronic respiratory disease are likely to have slower pain relief after THA. Urinary incontinence had a deleterious effect on functional improvement over a 6 month recovery.  Using patient-centered care in managing these conditions before surgery may  help patients attain more favourable outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-importance-of-comorbidity-in-understanding-the-6-month-trajectories-of-pain-and-function-after-total-hip-arthroplasty/