Abstract
Background
Hip replacement surgery is an effective treatment, however quantitative outcome does not necessarily delineate the true picture. It is important to triangulate data methods in order to ascertain important contextual factors that may influence patient perception.
Aims
The aim of the current study was to explore the patient perception on resurfacing hip arthroplasty (RHA) and mini-hip arthroplasty (MHA) in a unique cohort where each patient has received a resurfacing on one side and a mini-hip on the contralateral side using both quantitative and qualitative measures (Fig. 1).
Materials and methods
We identified patients in our Practice database that had undergone RHA on one side and MHA in the opposite hip. All prostheses were implanted by two experienced surgeons using a posterior approach and followed a standard anaesthetic protocol, post-operative care and rehabilitation guidelines. The patients received Cormet 2000 hip resurfacing and MiniHip (Corin®, Ciencester, UK) implants. Data were collected pre-operatively and post-operatively at weeks 6, 12, 26 52 and annually thereafter. The data included demographic details, mHHS (modified Harris Hip Score), patient satisfaction and a qualitative semi-structured interview. Data analysis was done using both quantitative (descriptive statistics, student's t-test) and qualitative (constant comparative method of grounded theory).
Results
There were 24 hips in 12 patients with mean age of 63.6 years (range 42,81) and a mean follow-up of 5.3 years (SD 4.2). The mean mHHS in pre-operative and one-year post-operative period for RHA was 50.9 (SD 22.9, range 9,71) and 82.6 (SD 11.2, range 67,91) respectively with a mean improvement of 32.9. The mean mHHS in pre-operative and one-year post-operative period for MHA was 47.83 (SD 14.6, range 20,62) and 83.2 (SD 27.3 range 53,94) respectively with mean improvement of 35.3. There was no significant difference in mHHS in the two groups (p=0.26). However, the qualitative analysis showed that a patient's perception of improvement did not always reflect the validated score improvement such as in mHHS. In 8/24 of arthroplasty cases the mHHS indicated a high return to functionality, however, interview highlighted perception of a reduction in certain aspects such as range of movement and ability to perform at a high-level such as competitive windsurfing (2/24), skiing (6/24) or martial arts (2/24). The results, therefore, suggest that the quantitative data is not sensitive enough to deduce return to function in a specialised subset of patients. The interviews indicate a marginal preference for resurfacing due to improved stability. However, the differential to the satisfaction with the mini hip was not sufficient for the potential metal ion problem to be ignored and therefore mini hip was shown to offer a reasonable bone-conserving alternative.
Conclusions
Results indicate the need for more than just a quantitative score to demonstrate satisfaction and that RHA generally offers better results although when the metal ion problem is taken into account the MHA can offer sufficient function and satisfaction as an alternative.
