Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

BMC Musculoskeletal Disorders

Research Article

Perla J. Marang-van de Mheen¹  Thea P. M. Vliet Vlieland²  Rob G. H. H. Nelissen²  Stefanie N. Hofstede²  Maaike G. J. Gademan³ 

[1] Department of Medical Decision Making, J10-S, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands;Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands;Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands;Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands;

关键词: Osteoarthritis;    Hip arthroplasty;    Review;    Predictors;    Outcome;   

DOI  :  10.1186/s12891-016-1070-3

 received in 2016-02-12, accepted in 2016-05-11,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThis systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA).MethodsWe performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects.ResultsThirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI.ConclusionThere is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups.Trial registrationThis systematic review was registered in Prospero, registration number RD42014009977.

【 授权许可】

CC BY   
© Hofstede et al. 2016