Impact of Comorbidities on Outcome After Total Hip Arthroplasty
Wissenschaftlicher Artikel/Review - 19.04.2017
Loth Fanny L, Giesinger Johannes M, Giesinger Karlmeinrad, MacDonald Deborah J, Simpson A Hamish R W, Howie Colin R, Hamilton David F
Patient-reported outcome scores gain increasing importance in quantifying clinical success and procedure remuneration. Our aim was to evaluate the impact of comorbidity on joint-specific outcome and general health in patients undergoing elective total hip arthroplasty (THA).
Longitudinal data on THA procedures were used to evaluate the association between comorbidity and surgical outcome in terms of joint-specific measures and general health (Forgotten Joint Score-12 [FJS-12], Oxford Hip Score [OHS], and Short Form-12) at 1-year follow-up. Comorbidities comprised the Charlson comorbidity index (CCI), low back pain (LBP), pain from other joints (POJ), and body mass index.
We analyzed data from 251 THA patients (age: 67.7 ± 11.8 years; 58.2% female). Most common conditions were POJ (75.9%), LBP (55.1%), connective tissue disease (12.1%), and diabetes (5.6%). With regard to postoperative improvement, we did not find statistically significant differences between patients with or without CCI comorbidities (FJS-12, +38.7 vs +43.2, P = .370; OHS, +15.6 vs +17.9, P = .100) or POJ (FJS-12, +39.9 vs +45.1, P = .325; OHS, +17.3 vs +16.6, P = .645). Patients with LBP showed less improvement on the FJS-12 than those without LBP (+35.6 vs +49.1; P = .002), whereas no difference was found for the OHS (+17.9 vs +16.5; P = .266).
Patients with comorbid conditions report lower preoperative and postoperative outcome scores compared with patients with no such conditions; however, there was no statistically significant association of CCI comorbidities and POJ with postoperative improvement in joint-specific outcomes. LBP was found to have a negative impact on postoperative improvement in terms of joint awareness.