No decline in high patient satisfaction after total hip arthroplasty at long-term follow-up

  • P. P. Schmitz
  • J. L. C. van Susante
  • A. Hol
  • R. Brokelman
  • C. J. M. van LoonEmail author
Original Article • HIP - ARTHROPLASTY



Patient satisfaction is gaining popularity as an important outcome parameter in today’s healthcare system and in particular in evaluating the outcome of joint arthroplasty. Total hip arthroplasty (THA) is a very successful procedure with reports on high patient satisfaction at short-term follow-up. Commonly used clinical outcome parameters remain good at long-term follow-up; however, whether this also accounts for patient satisfaction remains unclear. This study presents a prospective follow-up of patient satisfaction after THA, and a possible correlation with common outcome parameters was established.


This study entails a concise follow-up of an earlier study on patient satisfaction 2.5 years after THA. Patient satisfaction was repeatedly measured with a visual analogue scale (VAS) after a mean follow-up of 13.5 (12.6–14.2) years in a prospective cohort of 147 patients (153 THAs). In addition, VAS pain and common clinical outcome parameters (WOMAC, OHS and SF-36) were also reassessed and were compared with short-term results after a mean follow-up of 2.5 (1.3–3.0) years.


At a follow-up of 13.5 (12.6–14.2) years, the median VAS for satisfaction was 95 (26–100) compared to a median VAS satisfaction of 98 (0–100) at earlier follow-up (p = 0.781). Overall, the clinical outcome parameters also remained good at long-term follow-up without significant changes. However, a rather low correlation with VAS satisfaction was encountered. Pain during activity showed the highest correlation (− 0.686) with VAS satisfaction.


Patient satisfaction after THA remains high after prolonged follow-up. Apparently patients do not get used to the successful results of their THA. A rather low correlation with common clinical outcome parameters suggests that patient satisfaction is a separate entity. Since patient satisfaction correlated best with pain during activity, this is probably the most important aspect in patient satisfaction. Measurement of patient satisfaction has additional value and may even replace some of the more commonly used questionnaires.


Patient satisfaction Long term Total hip arthroplasty VAS 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standard

The procedures followed were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki Declaration and its later amendments.


  1. 1.
    Naal FD, Impellizzeri FM, Lenze U, Wellauer V, Von Eisenhart-Rothe R, Leunig M (2015) Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients’ perspective. Qual Life Res 24:2917–2925. CrossRefGoogle Scholar
  2. 2.
    Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 64(1):34–37. CrossRefGoogle Scholar
  3. 3.
    Hamilton D, Henderson GR, Gaston P, MacDonald D, Howie C, Simpson AH (2012) Comparative outcomes of total hip and knee arthroplasty: a prospective cohort study. Postgrad Med J 88:627–631. CrossRefGoogle Scholar
  4. 4.
    Amlie E, Havelin LI, Furnes O, Baste V, Nordsletten L, Hovik O, Dimmen S (2014) Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty: a cross-sectional questionnaire study of 1476 patients 1–3 years after surgery. Acta Orthop 85(5):463–469. CrossRefGoogle Scholar
  5. 5.
    Lindgren JV, Wretenberg P, Kärrholm J, Garellick G, Rolfson O (2014) Patient-reported outcome is influenced by surgical approach in total hip replacement: a study of the Swedish Hip Arthroplasty Register including 42,233 patients. Bone Joint J 96-B(5):590–596. CrossRefGoogle Scholar
  6. 6.
    Rolfson O, Kärrholm J, Dahlberg LE, Garellick G (2011) Patient-reported outcomes in the Swedish Hip Arthoplasty Register. Results of a nationwide prospective observational study. J Bone Joint Surg 93-B:867–875. CrossRefGoogle Scholar
  7. 7.
    Brokelman RB, Haverkamp D, van Loon C, Hol A, van Kampen A, Veth R (2012) The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol 3(2):101–105. CrossRefGoogle Scholar
  8. 8.
    Bengtsson A, Donahue G, Nemes S, Garellick G, Rolfson O (2017) Consistency in patient-reported outcomes after total hip replacement: a 6-year registry follow-up of 15,755 patients. Acta Orthop 88(5):484–489. CrossRefGoogle Scholar
  9. 9.
    Sanz-Reig J, Lizaur-Utrilla A, Llamas-Merino I, Lopez-Prats FJ (2011) Cementless total hip arthroplasty using titanium, plasma-sprayed implants: a study with 10–15 years of follow-up. Orthop Surg (Hong Kong) 19(2):169–173. CrossRefGoogle Scholar
  10. 10.
    Sandiford NA, Butler-Manuel A, Apthorp HD, East DJ, Hinves BL, Shepperd JA (2014) Primary total hip arthroplasty with a proximally HA-coated titanium femoral component: results at 10–15-year follow-up. Eur J Orthop Surg Traumatol 24(7):1211–1215. CrossRefGoogle Scholar
  11. 11.
    Yang Y, Galak J (2015) Sentimental value and its influence on hedonic adaptation. J Pers Soc Psychol 109(5):767–790. CrossRefGoogle Scholar
  12. 12.
    Dolan P, Sutton M (1997) Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Soc Sci Med 44:1519–1530CrossRefGoogle Scholar
  13. 13.
    Robinson A, Dolan P, Williams A (1997) Valuing health status using VAS and TTO. Soc Sci Med 45:1289–1297CrossRefGoogle Scholar
  14. 14.
    Bellamy NW, Buchannan WW, Goldsmith CH, Cambell J, Stitt LW (1988) Validation study of WOMAC. J Rheumatol 15:1833–1840Google Scholar
  15. 15.
    Roorda L, Jones C, Waltz M et al (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63:36–42CrossRefGoogle Scholar
  16. 16.
    Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E (1998) Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations. J Clin Epidemiol 51:1055–1068CrossRefGoogle Scholar
  17. 17.
    Katz JN, Larson MG, Phillips CB, Fossel AH, Liang MH (1992) Comparative measurement sensitivity of short and longer health status instruments. Med Care 30:917–925CrossRefGoogle Scholar
  18. 18.
    Gosens T, Hoefnagels NH, de Vet RC, Dhert WJ, van Langelaan EJ, Bulstra SK, Geesink RG (2005) The “Oxford Heup Score”: the translation and validation of a questionnaire into Dutch to evaluate the results of total hip arthroplasty. Acta Orthop Scan 76(2):204–211CrossRefGoogle Scholar
  19. 19.
    Wylde V, Blom AW (2009) Assessment of outcomes after hip arthroplasty. Hip Int 19:1–7CrossRefGoogle Scholar
  20. 20.
    Shan L, Shan B, Graham D, Saxena A (2013) Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthr Cartil 22(3):389–406. CrossRefGoogle Scholar
  21. 21.
    Koutras C, Antoniou SA, Talias MA, Heep H (2015) Impact of total hip resurfacing arthroplasty on health-related quality of life measures: a systematic review and meta-analysis. J Arthroplasty 30(11):1938–1952. CrossRefGoogle Scholar
  22. 22.
    Matharu GS, McBryde CW, Treacy RB, Pynsent WB, Pynsent PB (2013) Impact of active patient follow-up on worst-case implant survival analysis. Hip Int 23(3):259–262. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • P. P. Schmitz
    • 1
  • J. L. C. van Susante
    • 1
  • A. Hol
    • 1
  • R. Brokelman
    • 2
  • C. J. M. van Loon
    • 1
    Email author
  1. 1.Department of OrthopedicsRijnstate HospitalArnhemThe Netherlands
  2. 2.Department of OrthopedicsDeventer HospitalDeventerThe Netherlands

Personalised recommendations