PRIMARY VERSUS REVISION TOTAL HIP ARTHROPLASTY: QUALITY-OF-LIFE AND PATIENT SATISFACTION AT FIVE YEARS AND INFLUENCE OF AGE, OBESITY AND CO-MORBID CONDITIONS

Abstract

Purpose of the study: Revision total hip arthroplasty (rTHA) is associated with higher mortality than primary total hip arthroplasty (pTHA). The functional outcome after rTHA is globally satisfactory but less so than with primary implantation. Nevertheless, data are scarce. Patients undergoing revision procedures are older and have more co-morbid conditions. In this context, we evaluated quality-of-life and patient satisfaction five years after implantation, comparing rTHA versus pTHA. We analyzed the impact of age, obesity, and co-morbid conditions.

Material and methods: The study cohort included all patients undergoing pTHA (n=471) OR rTHA (n=124) in our unit between 1996 and 2000. Five years postoperatively, we noted the Harris hip score (HHS) and patient satisfaction, assessed on a visual analog scale (VAS) from 1 to 10.

Results: The rTHA patients were older (72 yeras versus 68 years, p=0.004), more frequently obese (BMI30: 33% versus 19%, p=0.003) and presented more co-morbid conditions involving medical ( 2: 46% versus 21%, p< 0.001) and orthopedic ( 2: 13% versus 7%, p=0.053) problems. Five years after surgery, quality-of-life and patient satisfaction were much lower after rTHA than after pTHA (HHS < 70; 31% versus 9%, p< 0.001; satisfaction score 8: 68% versus 85%, p< 0.001). Adjustment for the preoprative status (ASA, medical and orthopedic comorbidity, BMI, gender, age) attenuated these differences which nevertheless remained significant [non-adjusted HHS difference: 11.5 (95%CI: 7.4–15.7); adjusted difference: 8.8 (95%CI: 5.5–12.1)]. In both groups, a low HHS was associated with BMI ≥ 30, poor preoperative function, 2 joints affected, elderly age. Obesity was associated with even poorer results after rTHA than after pTHA (non-adjusted difference, p=0.026).

Discussion: Quality-of-life and patient satisfaction at five years were clearly poorer after rTHA than after pTHA. This is in agreement with data in the literature. The difference is explained in particular by greater patient age and more associated comorbidities for rTHA. Obesity is a prognostic factor which is more unfavorable after rTHA than after pTHA.

Conclusion: Considering the risks and benefits of revision surgery, it is important to recognize not only the surgical factors but also the characteristic features of the patients.