Background Pain and function are the most important outcomes after hip arthroplasty. While focus has been on revision rates, less attention has been paid to factors that are associated with suboptimal patient-reported outcomes such as pain and function.
Objectives To assess the association of underlying diagnosis with patient-reported outcomes (PROs) after revision total hip arthroplasty.
Methods We used prospectively collected data from the Mayo Clinic Total Joint Registry, a large U.S. institutional registry, that collects pre- and post-operative pain and function outcomes using a validated Hip questionnaire in all patients who undergo THA at the Mayo Clinic. We used data on all revision THAs from 1993-2005 captured electronically in the registry. We used logistic regression to assess the odds of moderate-severe index hip pain and moderate-severe ADL limitations 2- and 5-years after revision THA. Odds ratios (OR) and 95% confidence intervals (CIs) are presented.
Results The underlying diagnosis was loosening, wear or osteolysis in 73% and 75%; dislocation, bone or prosthesis fracture, instability or non-union in 17% and 15%; and failed prior arthroplasty with components removed or infection in 11% and 11%, respectively. In multivariable-adjusted analyses that included 15-additional variables including preoperative ADL limitations, compared to patients with loosening/wear/osteolysis, patients with dislocation/fracture/instability/non-union had OR of 2.2 (95% CI, 1.3-3.5; p=0.002) and those with failed prior arthroplasty/infection had OR of 1.6 (95% CI, 1.0-2.8; p=0.06). At 5-years, ORs were lower and differences were no longer significant Moderate-severe pain did not differ significantly by diagnosis, at 2- or 5-years in multivariable adjusted analyses, with one exception, i.e. failed prior arthroplasty/infection had a trend towards significance with odds ratio of 1.9 (95% CI, 0.9-3.8; p=0.07).
Conclusions Underlying diagnosis is independently associated with ADL limitations, but not pain, at 2-years after revision THA. Patients should be informed of the risk of poorer outcomes based on their diagnosis.
Disclosure of Interest J. Singh Grant/research support from: takeda, Savient, Consultant for: takeda, Savient, allergan, Ardea, Regeneron, Novartis, D. Lewallen: None Declared