Abstract
Various parameters have been considered as possible predictors of health-related quality-of-life outcomes after THA in patients with hip osteoarthritis. We hypothesized the preintervention health status is the main and more homogeneous predictor of changes of the different aspects of health-related quality-of-life outcomes, mental health status has an important influence on results, whereas other sociodemographic or clinical factors had only a punctual influence. All patients who fulfilled the selection criteria completed the Medical Outcomes Study SF-36 and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 6 months after the intervention. Seven hundred eighty-eight patients completed the questionnaire before the intervention and 590 completed it (74.9%) at 6 months. The preintervention score in each SF-36 and WOMAC domain and the SF-36 mental health domain predicted changes after the intervention. Female gender, having comorbidities, contralateral hip osteoarthritis, or back pain predicted less improvement on some SF-36 domains. Older age, the presence of contralateral hip osteoarthritis, or back pain predicted less improvement on some of the WOMAC domains. Preintervention health status, measured by the WOMAC or SF-36, and mental health status uniformly predicted health-related quality-of-life changes, whereas some clinical parameters predicted some domains. SF-36 and WOMAC seem to be appropriate tools for predicting THA outcomes.
Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Alonso J, Prieto L, Anto JM. [The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results] [in Spanish]. Med Clin (Barc). 1995;104:771–776.
Angst F, Aeschlimann A, Steiner W, Stucki G. Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis. 2001;60:834–840.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
Bischoff-Ferrari HA, Lingard EA, Losina E, Baron JA, Roos EM, Phillips CB, Mahomed NN, Barrett J, Katz JN. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum. 2004;51:829–835.
Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J, Coyte P. Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care. 1995;33(suppl):AS131–AS144.
Brander VA, Malhotra S, Jet J, Heinemann AW, Stulberg SD. Outcome of hip and knee arthroplasty in persons aged 80 years and older. Clin Orthop Relat Res. 1997;345:67–78.
Caracciolo B, Giaquinto S. Determinants of the subjective functional outcome of total joint arthroplasty. Arch Gerontol Geriatr. 2005;41:169–176.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
Davis AM, Agnidis Z, Badley E, Kiss A, Waddell JP, Gross AE. Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am. 2006;88:685–691.
Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI. Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis: Western Ontario and McMaster Universities Osteoarthritis Index. Clin Rheumatol. 2002;21:466–471.
Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI, Arenaza JC, Gutierrez LF. Effect of patient characteristics on reported outcomes after total knee replacement. Rheumatology (Oxford). 2007;46:112–119.
Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.
Ethgen O, Vanparijs P, Delhalle S, Rosant S, Bruyère O, Reginster JY. Social support and health-related quality of life in hip and knee osteoarthritis. Qual Life Res. 2004;13:321–330.
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Bélisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–1728.
Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Bélisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46:3327–3330.
Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement: comorbidity and outcomes after hip replacement. Med Care. 1993;31:141–154.
Hajat S, Fitzpatrick R, Morris R, Reeves B, Rigge M, Williams O, Murray D, Gregg P. Does waiting for total hip replacement matter? Prospective cohort study. J Health Serv Res Policy. 2002;7:19–25.
Harse JD, Holman CD. Charlson’s Index was a poor predictor of quality of life outcomes in a study of patients following joint replacement surgery. J Clin Epidemiol. 2005;58:1142–1149.
Hawker G, Melfi C, Paul J, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995;22:1193–1196.
Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res. 1993;289:175–179.
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med. 2001;161:454–460.
Katz JN, Wright EA, Guadagnoli E, Liang MH, Karlson EW, Cleary PD. Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Arthritis Rheum. 1994;37:687–694.
Kelly KD, Voaklander DC, Johnston DW, Newman SC, Suarez-Almazor ME. Change in pain and function while waiting for major joint arthroplasty. J Arthroplasty. 2001;16:351–359.
Kennedy DM, Hanna SE, Stratford PW, Wessel J, Gollish JD. Preoperative function and gender predict pattern of functional recovery after hip and knee arthroplasty. J Arthroplasty. 2006;21:559–566.
Lingard EA, Katz JN, Wright EA, Sledge CB. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004;86:2179–2186.
MacWilliam CH, Yood MU, Verner JJ, McCarthy BD, Ward RE. Patient-related risk factors that predict poor outcome after total hip replacement. Health Serv Res. 1996;31:623–638.
Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29:1273–1279.
Mahon JL, Bourne RB, Rorabeck CH, Feeny DH, Stitt L, Webster-Bogaert S. Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study. CMAJ. 2002;167:1115–1121.
March LM, Cross MJ, Lapsley H, Brnabic AJ, Tribe KL, Bachmeier CJ, Courtenay BG, Brooks PM. Outcomes after hip or knee replacement surgery for osteoarthritis: a prospective cohort study comparing patients’ quality of life before and after surgery with age-related population norms. Med J Aust. 1999;171:235–238.
McGuigan FX, Hozack WJ, Moriarty L, Eng K, Rothman RH. Predicting quality-of-life outcomes following total joint arthroplasty: limitations of the SF-36 Health Status Questionnaire. J Arthroplasty. 1995;10:742–747.
Moran M, Walmsley P, Gray A, Brenkel IJ. Does body mass index affect the early outcome of primary total hip arthroplasty? J Arthroplasty. 2005;20:866–869.
Nilsdotter AK, Lohmander LS. Age and waiting time as predictors of outcome after total hip replacement for osteoarthritis. Rheumatology (Oxford). 2002;41:1261–1267.
Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS. Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis. 2003;62:923–930.
Nilsdotter AK, Roos EM, Westerlund JP, Roos HP, Lohmander LS. Comparative responsiveness of measures of pain and function after total hip replacement. Arthritis Rheum. 2001;45:258–262.
Norman-Taylor FH, Palmer CR, Villar RN. Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg Br. 1996;78:74–77.
Quintana JM, Escobar A, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. Osteoarthritis Cartilage. 2005;13:1076–1083.
Rissanen P, Aro S, Sintonen H, Slatis P, Paavolainen P. Quality of life and functional ability in hip and knee replacements: a prospective study. Qual Life Res. 1996;5:56–64.
Salaffi F, Carotti M, Grassi W. Health-related quality of life in patients with hip or knee osteoarthritis: comparison of generic and disease-specific instruments. Clin Rheumatol. 2005;24:29–37.
Sharma L, Cahue S, Song J, Hayes K, Pai YC, Dunlop D. Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. Arthritis Rheum. 2003;48:3359–3370.
Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL. Defining the relationship between obesity and total joint arthroplasty. Obes Res. 2001;9:219–223.
Street J, Lenehan B, Flavin R, Beale E, Murray P. Do pain referral patterns determine patient outcome after total hip arthroplasty? Acta Orthop Belg. 2005;71:540–547.
Towheed TE, Hochberg MC. Health-related quality of life after total hip replacement. Semin Arthritis Rheum. 1996;26:483–491.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.
Wolfe F. Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia. Rheumatology (Oxford). 1999;38:355–361.
Acknowledgments
We are grateful for the collaboration of Drs. Ignacio Vidaurreta and Isidoro Garcia, the support of the staff members of the different services, research, and quality units, and the medical records sections, of the participating hospitals.
Author information
Authors and Affiliations
Corresponding author
Additional information
One or more of the authors (JMQ) have received funding from grants from the Fondo de Investigación Sanitaria (98/001-01 to 03) and the thematic networks, Red IRYSS, of the Instituto de Salud Carlos III (G03/220).
Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.
This work was performed at Unidad de Investigación, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP).
About this article
Cite this article
Quintana, J.M., Escobar, A., Aguirre, U. et al. Predictors of Health-related Quality-of-life Change after Total Hip Arthroplasty. Clin Orthop Relat Res 467, 2886–2894 (2009). https://doi.org/10.1007/s11999-009-0868-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-009-0868-9