Abstract
Background:
Hip arthroplasty is very successful in order to alleviate pain and improve health-related quality of life. Health-care costs are constantly growing and the burden of patients with hip disease has increased dramatically. Careful consideration of the patients'need and expectations include not only the proper indication for surgery but also choice of method. Hip resurfacing (HRA) has been popularized during the last decade, being bone conservative, capable to restore the anatomical hip center and lower the risk of dislocation. Some HRA-designs have proven good long-term survival rate while others have shown an unacceptable high amount of loosening and been recalled. Yet, for a selected group of patients HRA may be advantageous to THA regarding health-related quality of life. A fundamental prerequisite understanding today's and tomorrow's request on hip arthroplasty is to measure outcomes from patients' perspectives. In this pilot study we compared the patient-reported outcome measures after hip resurfacing with THA using validated general and hip disease specific instruments.
Methods:
A questionnaire was sent to 108 randomly selected patients (72% male) of a cohort of 259 patients (Charnley A+B) who had had uni- or bilateral (two stages) HRA for a period of at least six months. Maximal follow-up time was 7 years. Mean age was 50.2 years (males) and 46.2 years (females) respectively. Patients were reporting EQ-5D and self assessed health-quality (0–100%). In addition, a minor group randomly selected, reported their activity that was graded according to UCLA-activity score. As preoperative EQ-5D baseline, a matched group of 40 patients from the hospital's database scheduled for HRA served.
Results:
92 of 108 questionnaires with EQ-5D and self assessed health quality were complete. The mean postoperative EQ-5D was 0.89 (0.30 preoperative) and self assessed health quality being 59.3% (15–100) preoperatively was 80.2% (40–100) postoperatively. UCLA- activity score was 7.2 (4–9) postoperative. Of the whole group of 259 patients, three patients suffered from nerve palsy (two transient), two early cupmigrations (revised), one psoas-impingement and one AVN with cervical fracture (both revised), one deep infection, one ALTR and one dislocation (high-energy trauma).
Conclusion:
Traditional outcome measures often fail to describe outcome from the patients' perspectives. This pilot study, with its limitations, shows that patients' health-related quality of life, as measured with EQ-5D after HRA is comparable to or better than that of THA. Patients with HRA in general seem to reach high activity level. However, adverse reactions to metal debris are escalating and with HRA compared to proven THA-designs the risk of complications, e.g., early loosening, especially in females, is higher. For men, no significant difference in survival rate is reported for HRA compared to THA. Yet, HRA should be considered in subgroups of patients (younger, active men), in order to gain high patient satisfaction.
