QUALITY OF LIFE AFTER TOTAL HIPARTHROPLASTY – THE EFFECT OF CO-MORBIDITY AND COMPLICATIONS

Abstract

Background and Aim: SF-36 has been used frequently as a measurement tool to evaluate the effect of total hip arthroplasty (THA) operation on the patient’s quality of life (QoL). There is though a lack of data describing how QoL is affected if the patients have medical co-morbidities before the operation or if they suffer postoperative complications after THA. With this study we wanted to describe the effect on QoL of pre-operative co-morbidity and post-operative surgical and thromboembolic complications after THA.

Material and methods: This study was part of the ESMOS study where 500 consecutive THA patients (both primary and revision THA) were followed prospectively for one year, with the purpose to collect all surgical and thromboembolic events that these patients experienced. The patients were asked to fill in a SF-36 form the day before the operation and one year after the operation. 397 (79.4%) of the patients had two forms sufficient for further data analysis in this study. Co-morbidity data was measured before the operation. Complications were measured with structured interviews by two study persons the fifth postoperative day and at telephone interviews after 3 and 12 month. All reported events were verified according to predefined criteria in the patient’s medical journal.

Results: The majority of the THA patients experienced a gain in their quality of life one year after THA. One year after THA the co-morbid patients had a significantly lower QoL score in all scales, but they still gained from the operation. Patients that experienced either a surgical or a thromboembolic complication had lower SF-36 score one year post-operatively compared to patients without complications. Subgroup analysis revealed that the small group of patients with deep infection, aseptic loosening or re-operation because of malfunction of the prosthesis had a fall in QoL compared to the pre-operative value and scored significantly worse than all other patient groups.

Conclusion: THA is a successful operation when QoL is measured one year postoperatively. Pre-operative co-morbidity and postoperative surgical or thrombo-embolic complications does give a smaller gain in QoL compared to patients without co-morbidity and patients without complications. The small but important group of patients with deep infection, aseptic loosening and malfunction re-operation, were the only to loose QoL one year after THA in this study.