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Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty

¹ Toronto Western Hospital, MP 11-322, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail address: adavis{at}uhnresearch.ca
² Department of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, ON M5G 1X5, Canada. E-mail address for Z. Agnidis: zoe.agnidis{at}utoronto.ca. E-mail address for A.E. Gross: allan.gross{at}utoronto.ca
³ Arthritis Community Research and Evaluation Unit, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail address for E. Badley: badley{at}uhnres.utoronto.ca
⁴ Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, G Wing, 1st Floor, Room 144, Toronto, ON M4N 3M5, Canada. E-mail address for A. Kiss: kiss{at}ices.on.ca
⁵ University of Toronto, St. Michael's Hospital, 30 Bond Street, Room 5013, Bond Wing, Toronto, ON M5B 1W8, Canada. E-mail address for J.P. Waddell: waddellj{at}smh.toronto.on.ca

Investigation performed at Mount Sinai Hospital, Toronto Western Hospital—University Health Network, Sunnybrook and Women's College Health Sciences Centre, and St. Michael's Hospital, Toronto, Ontario, Canada

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NOTE: The following surgeons enrolled patients in this study: J. Roderick Davey, Toronto Western Hospital of University Health Network; Jeffrey Gollish, Sunnybrook and Women's College Hospital; Allan E. Gross, Mount Sinai Hospital; Caroline Hutchinson, formerly of Mount Sinai Hospital; Hans Kreder, Sunnybrook and Women's College Hospital; Nizar Mahomed, Toronto Western Hospital of University Health Network; Emil Schemitisch, St. Michael's Hospital; and, James Waddell, St. Michael's Hospital. The authors also acknowledge the contributions of Dr. Khaled Saleh and Dr. Amiram Gafni to this study.

In support of their research for or preparation of this manuscript, one or more of the authors received an Operating Grant (No. 98/0012) from The Arthritis Society (Canada). A.M. Davis is supported by a Health Career Award from the Canadian Institutes of Health Research. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: One hundred and twenty-six patients (126 hips) were entered prospectively into the study when their name was placed on the waiting list for surgery. Baseline measures included demographic factors, comorbidities, and the responses to the Short Form-36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaires. Follow-up was carried out at six-month intervals while the patient was waiting for the surgery; within one week prior to the surgery; and at six, twelve, and twenty-four months after the surgery. Patient age and gender, the preoperative WOMAC pain and function scores, the physical and mental component scores of the SF-36, comorbidities, the number of revisions, bilateral joint replacement, and the severity of the revision were evaluated as possible predictors of ultimate pain and function as measured with the WOMAC instrument.

Results: The mean age of the patients was 68.6 years. Improvement in WOMAC pain and function scores plateaued at six months. The mean pain score (and standard deviation) improved from 9.4 ± 4.1 points preoperatively to 3.9 ± 3.9 points at six months postoperatively, and the mean function score improved from 35.4 ± 14.1 to 19.1 ± 13.2 points. Preoperative pain (p = 0.002) and comorbidity (p = 0.02) were significant predictors of pain at two years. There was a trend toward preoperative function predicting function at twenty-four months (p = 0.07). There was no significant deterioration in the WOMAC pain or function score while the patients waited for surgery. Twenty-eight patients had complications. When the time that the patient waited for the surgery and complications were added to the models, only complications were found to be predictive of outcome (p = 0.04 for pain and p = 0.05 for function). Four patients required repeat revision during the follow-up period.

Conclusions: Patients with better preoperative pain scores and fewer comorbidities have better outcomes following revision total hip arthroplasty. Although the time that the patient waited for the revision was not predictive of the ultimate WOMAC pain and function scores, we believe that performing revision arthroplasty before the patient has substantial functional compromise potentially improves the outcome.

Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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