Patients with osteoarthritis and avascular necrosis have better functional outcomes and those with avascular necrosis worse pain outcomes compared to rheumatoid arthritis after primary hip arthroplasty: a cohort study

BMC Medicine

David G Lewallen¹  Jasvinder A Singh² 

[1] Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA;University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA

关键词: Risk factors;    Patient-reported outcomes;    Joint replacement;    Arthroplasty;    Function;    Pain;    Avascular necrosis;    Rheumatoid arthritis;    Osteoarthritis;    Diagnosis;    Total hip replacement;   

Others  :  855684
DOI  :  10.1186/1741-7015-11-210

 received in 2013-06-10, accepted in 2013-08-30,  发布年份 2013

【 摘 要 】

Background

This study was conducted to assess whether patient-reported outcomes (PROs) differ by the underlying diagnosis (rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA), avascular necrosis of bone (AVN), other) in patients undergoing primary total hip arthroplasty (THA).

Methods

We used prospectively collected data to assess the association of diagnosis with index hip function and pain. Moderate-severe activity limitation and moderate-severe pain were assessed at two- and five-year follow-up after primary THA using multivariable-adjusted logistic regression analyses. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results

There were 5,707 primary THAs at two-years and 3,289 at five-years, 51% were women and the mean age was 65 years. The underlying diagnosis was RA in 3%, OA in 87%, AVN in 7% and other in 3%. In multivariable-adjusted analyses, compared to RA, diagnoses of OA and AVN were significantly associated with lower odds of moderate-severe activities of daily living limitations with an OR (95% CI) of 0.5 (0.3 to 0.8) (P = 0.01) and 0.4 (0.2 to 0.8) (P = 0.01), respectively, at two-years, but not at five-years, 0.7 (0.4 to 1.4) (P = 0.36) and 0.9 (0.4 to 1.8) (P = 0.78), respectively. At two-years, neither OA nor AVN were significantly associated with higher odds of moderate-severe pain (1.6 (0.6 to 4.5) (P = 0.40) and 2.8 (0.9 to 8.5) (P =0 0.06)), respectively. At five-years, AVN was associated with higher odds of moderate-severe pain with OR 4.1 (1.2 to 14.1) (P = 0.02), but not OA, 2.1 (0.7 to 6.5) (P = 0.22).

Conclusions

We found that patients with OA and AVN had better functional outcomes and those with AVN worse pain outcomes after primary THA, compared to patients with RA/inflammatory arthritis. Insights into mediators of these relationships are needed to better understand these associations.

【 授权许可】

   
2013 Singh and Lewallen; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Learmonth ID, Young C, Rorabeck C: The operation of the century: total hip replacement. Lancet 2007, 370:1508-1519.
• [2]Ng CY, Ballantyne JA, Brenkel IJ: Quality of life and functional outcome after primary total hip replacement. A five-year follow-up. J Bone Joint Surg Br 2007, 89:868-873.
• [3]Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP: Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop 2007, 78:108-115.
• [4]Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ 3rd, Kurland RL, Berry DJ: A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc 2010, 85:898-904.
• [5]Kurtz S, Ong K, Lau E, Mowat F, Halpern M: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007, 89:780-785.
• [6]Cram P, Lu X, Kaboli PJ, Vaughan-Sarrazin MS, Cai X, Wolf BR, Li Y: Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. JAMA 2011, 305:1560-1567.
• [7]Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J, Lingard EA, Harris WH, Poss R, Lew RA, Guadagnoli E, Wright EA, Losina E: Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum 2003, 48:560-568.
• [8]Engh CA, Bobyn JD, Glassman AH: Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 1987, 69:45-55.
• [9]Borstlap M, Zant JL, Van Soesbergen M, Van der Korst JK: Effects of total hip replacement on quality of life in patients with osteoarthritis and in patients with rheumatoid arthritis. Clin Rheumatol 1994, 13:45-50.
• [10]Kirwan JR, Currey HL, Freeman MA, Snow S, Young PJ: Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol 1994, 33:357-360.
• [11]Creighton MG, Callaghan JJ, Olejniczak JP, Johnston RC: Total hip arthroplasty with cement in patients who have rheumatoid arthritis. A minimum ten-year follow-up study. J Bone Joint Surg Am 1998, 80:1439-1446.
• [12]STROBE Statement: Strengthening the reporting of observational studies in epidemiology. Available at: http://www.strobestatement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_combined.pdf webcite. 2007 [cited 09/06/2012]
• [13]Rand JA, Ilstrup DM: Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am 1991, 73:397-409.
• [14]Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS: Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 2003, 85-A:259-265.
• [15]Kavanagh BF, Fitzgerald RH Jr: Clinical and roentgenographic assessment of total hip arthroplasty. A new hip score. Clin Orthop Relat Res 1985, 193:133-140.
• [16]McGrory BJ, Freiberg AA, Shinar AA, Harris WH: Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire. J Arthroplasty 1996, 11:565-571.
• [17]McGrory BJ, Morrey BF, Rand JA, Ilstrup DM: Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 1996, 11:47-57.
• [18]Andersson G: Hip assessment: a comparison of nine different methods. J Bone Joint Surg Br 1972, 54:621-625.
• [19]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45:613-619.
• [20]Gonzalez Saenz De Tejada M, Escobar A, Herrera C, Garcia L, Aizpuru F, Sarasqueta C: Patient expectations and health-related quality of life outcomes following total joint replacement. Value Health 2010, 13:447-454.
• [21]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.
• [22]Wolfe F, Zwillich SH: The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum 1998, 41:1072-1082.
• [23]Singh JA, Lewallen DG: Predictors of activity limitation and dependence on walking aids after primary total hip arthroplasty. J Am Geriatr Soc 2010, 58:2387-2393.
• [24]Singh JA, Lewallen D: Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord 2010, 11:90. BioMed Central Full Text
• [25]Harris WH: Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969, 51:737-755.
• [26]Wright JG, Young NL: A comparison of different indices of responsiveness. J Clin Epidemiol 1997, 50:239-246.
• [27]Hoeksma HL, Van Den Ende CH, Ronday HK, Heering A, Breedveld FC: Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis 2003, 62:935-938.
• [28]McInnes IB, Schett G: The pathogenesis of rheumatoid arthritis. N Engl J Med 2011, 365:2205-2219.
• [29]Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, Kreder H, Hawker G: A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum 2012, 64:3839-3849.
• [30]Hawker GA, Badley EM, Borkhoff CM, Croxford R, Davis AM, Dunn S, Gignac MA, Jaglal SB, Kreder HJ, Sale JE: Which patients are most likely to benefit from total joint arthroplasty? Arthritis Rheum 2013, 65:1243-1252.
• [31]Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG, Brooks PM, Arthritis Cost and Outcome Project Group: A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage 2001, 9:137-146.
• [32]Harris WH, Sledge CB: Total hip and total knee replacement (2). N Engl J Med 1990, 323:801-807.
• [33]Harris WH, Sledge CB: Total hip and total knee replacement (1). N Engl J Med 1990, 323:725-731.
• [34]Johannson HR, Zywiel MG, Marker DR, Jones LC, McGrath MS, Mont MA: Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthop 2011, 35:465-473.
• [35]Rahman WA, Garbuz DS, Masri BA: Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes. Can J Surg 2013, 56:41-46.
• [36]Singh J, Sloan JA, Johanson NA: Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg 2010, 18:72-82.
• [37]Asch DA, Jedrziewski MK, Christakis NA: Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997, 50:1129-1136.
• [38]Quintana JM, Escobar A, Aguirre U, Lafuente I, Arenaza JC: Predictors of health-related quality-of-life change after total hip arthroplasty. Clin Orthop Relat Res 2009, 467:2886-2894.