Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches

Abstract

Background: Comparisons of patient-reported outcomes (PROs) based on surgical approach for total hip arthroplasty (THA) in the United States are limited to series from single surgeons or institutions. Using prospective data from a large, multicenter study, we compare preoperative to postoperative changes in PROs between posterior, transgluteal, and anterior surgical approaches to THA.

Methods: Patient-reported function, global health, and pain were systematically collected preoperatively and at 1, 3, and 6 months postoperatively from patients undergoing primary THA at 26 sites participating in the Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement (ClinicalTrials.gov: NCT02810704). Outcomes consisted of the brief Hip disability and Osteoarthritis Outcome Score, the Patient-Reported Outcomes Measurement Information System Physical Health score, and the Numeric Pain Rating Scale. Operative approaches were grouped by surgical plane relative to the abductor musculature as being either anterior, transgluteal, or posterior.

Results: Between 12/12/2016 and 08/31/2019, outcomes from 3018 eligible participants were examined. At 1 month, the transgluteal cohort had a 2.2-point lower improvement in Hip disability and Osteoarthritis Outcomes Score (95% confidence interval, 0.40-4.06; P = .017) and a 1.3-point lower improvement in Patient-Reported Outcomes Measurement Information System Physical Health score (95% confidence interval, 0.48-2.04; P = .002) compared to posterior approaches. There was no significant difference in improvement between anterior and posterior approaches. At 3 and 6 months, no clinically significant differences in PRO improvement were observed between groups.

Conclusion: PROs 6 months following THA dramatically improved regardless of the plane of surgical approach, suggesting that choice of surgical approach can be left to the discretion of surgeons and patients without fear of differential early outcomes.

Keywords: HOOS; anterior; hip arthroplasty; patient-reported outcomes; posterior; transgluteal.

Conflict of interest statement

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.10.017.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Appendix C.

Length of Stay and Discharge Disposition for Hip Cohort. CI, confidence interval.

Fig. 1.

Study cohort selection. * Specific time point follow-up rates were calculated using the following formula: #participantscompletingspecifiedsurvey#participantscompletingspecifiedsurvey+#participantspassedthroughwindowwithoutcompletingsurvey **Any follow-up was calculated using the following formula: #participantscompletinganysurvey#participantscompletinganysurvey+#participantspassedthrough6monthwindowwithoutcompletingsurvey PEPPER, Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement.

Fig. 2.

Patient-reported outcomes following total hip arthroplasty. Estimates are adjusted for age, sex, race, ethnicity, education, work status, alcohol use, smoking, and comorbidity. Preop, preoperative; HOOS Jr, the brief Hip disability and Osteoarthritis Outcome Score; PROMIS-PH, Patient-Reported Outcomes Measurement Information System Physical Health Summary; NPRS, Numeric Pain Rating Scale.

Fig. 3.

Proportion of participants achieving MCID at 1, 3, and 6 months. Calculated using unadjusted differences in each PRO between baseline and given month. MCID, minimum clinically important difference; PRO, patient-reported outcome.