Impact of Demographic Variables on Recovery After Total Hip Arthroplasty

Patient satisfaction and patient-reported outcomes do not vary by BMI class in total hip arthroplasty

PURPOSE

Obesity has been identified as a risk factor for postoperative complications in patients undergoing total hip arthroplasty (THA). This study aimed to investigate patient-reported outcomes, pain, and satisfaction as a function of body mass index (BMI) class in patients undergoing THA.

METHODS

1736 patients within a prospective observational study were categorized into BMI classes. Pre- and postoperative Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), satisfaction, and pain scores were compared by BMI class using one-way ANOVA.

RESULTS

Healthy weight patients reported the highest preoperative HOOS JR (56.66 ± 13.35) compared to 45.51 ± 14.45 in Class III subjects. Healthy weight and Class III patients reported the lowest (5.65 ± 2.01) and highest (7.06 ± 1.98, p < 0.0001) preoperative pain, respectively. Changes in HOOS JR scores from baseline suggest larger improvements with increasing BMI class, where Class III patients reported an increase of 33.7 ± 15.6 points at 90 days compared to 26.1 ± 17.1 in healthy weight individuals (p = 0.002). Fewer healthy weight patients achieved the minimal clinically important difference (87.4%) for HOOS JR compared to Class II (96.5%) and III (94.7%) obesity groups at 90 days postoperatively. Changes in satisfaction and pain scores were largest in the Class III patients. Overall, no functional outcomes varied by BMI class postoperatively.

CONCLUSION

Patients of higher BMI class reported greater improvements following THA. While risk/benefit shared decision-making remains a personalized requirement of THA, this study highlights that utilization of BMI cutoff may not be warranted based on pain and functional improvement.

Indoor and outdoor 10-Meter Walk Test and Timed Up and Go in patients after total hip arthroplasty: a reliability and comparative study

Introduction

The 10-Meter Walk Test (10MWT) and Timed Up and Go (TUG) are valid tools for gait performance and mobility assessment after total hip arthroplasty (THA). The study aimed to assess test-retest reliability of 10MWT and TUG in indoor and outdoor environments in patients in acute phase after THA and compare their indoor vs. outdoor performance during these tests.

Methods

Thirty-five inpatients performed 10MWT and TUG in indoor and outdoor settings on the second postoperative day. An additional evaluation session was performed after 1 hour under the supervision of the same operator. Test-retest reliability was assessed using Intraclass Correlation Coefficient (ICC: 2.1) and Minimal Detectable Change (MDC95), while paired t-tests were used to compare indoor vs. outdoor performance.

Results

Indoor (ICC: 0.94, MDC95: 0.13 m/s) and outdoor (ICC: 0.91, MDC95: 0.16 m/s) 10MWT at maximum speed and indoor (ICC: 0.92, MDC95: 2.5 s) and outdoor (ICC: 0.93, MDC95: 2.4 s) TUG revealed excellent reliability. Indoor (ICC: 0.86, MDC95: 0.16 m/s) and outdoor (ICC: 0.89, MDC95: 0.16 m/s) 10MWT at spontaneous speed revealed good reliability. Spontaneous (mean difference [MD]: 0.05 m/s, 95% confidence interval [CI95]: 0.03, 0.07, p < 0.001) and maximum (MD: 0.02 m/s, CI95: 0.01, 0.04, p < 0.001) 10MWT revealed higher gait speed when performed outdoors compared to indoors.

Conclusions

Indoor and outdoor 10MWT and TUG are reliable tests in acute phase after THA. Higher gait speed during outdoor 10MWT may depend on test score variability, due to MDs being lower than MDC95.