Abstract
Introduction:
Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient's mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA.
Methods:
Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models that were adjusted for all variables, including baseline mental and functional scores.
Results:
A total of 804 primary and 154 revision THA patients completed their post-operative questionnaires with an average follow-up of 491 and 487 days, respectively. Patients were confident in achieving their goals, with an average score of 8.0 ± 2.2 and 7.2 ± 2.8 for primary and revision THA patients, respectively. Having greater confidence was associated with a decreased rate of 30-day readmission for primary THA patients only (p = 0.006). For both primary and revision THA patients, having greater confidence was associated with higher HOOS functional scores (primary p < 0.001 and revision p = 0.004), improved HOOS pain scores (p < 0.001 and p = 0.011), and improved SF-12 physical component scores (p < 0.001 and p = 0.003).
Conclusions:
A patient's level of confidence in their ability to achieve specific functional outcomes following either primary or revision THA does affect their post-operative outcomes. When risk-stratifying patients for THA, patient's confidence may be as important as their medical comorbidities.
