QoL and Hip Function During the First Month After THA
QoL and Hip Function During the First Month After THA
EQ5D improved from 0.63 ± 0.02 preoperatively to 0.78 ± 0.03 at 31 days postoperatively (P <0.001, 100% statistical power) (Figure 1A). From day 13 after surgery, EQ5D improved significantly compared to preoperative values (61.9% statistical power). In comparison, the norm of EQ5D index values for the Danish population (age-matched) is 0.883 for men and 0.818 for women. The comprehensive QoL improved from 6.6 ± 0.3 preoperatively to 7.8 ± 0.3 at day 31 (P <0.001, 93.6% statistical power) (Figure 1B).
(Enlarge Image)
Figure 1.
(A) European Quality of Life in Five Dimensions (EQ5D) demonstrated better quality of life from day 13 after total hip arthroplasty (THA) (*indicates P <0.005 for values in paired comparison with the preoperative EQ5D index). (B) The comprehensive quality of life was measured with a 0-10 visual analog scale, and demonstrated better overall quality of life at 31 days after THA (* indicates P <0.005 for values in paired comparison with the preoperative EQ5D index).
OHS improved from 49 ± 2.9 to 73 ± 5.4 (P <0.001; 100% statistical power) during the first month postoperatively (Figure 2A). As expected, OHS decreased at day 1 postoperatively (17 ± 1) compared to the preoperative value (49 ± 2.9) (P <0.001; 100% statistical power). From day 13 (28 ± 1; P ¼0.04) OHS improved increasingly throughout the follow-up (93.2% statistical power).
(Enlarge Image)
Figure 2.
(A) Oxford Hip Score (OHS) showed decreased function of the hip at day 1 after total hip arthroplasty (THA). From day 4 to 10 OHS was similar to the preoperative THA score. From day 13 and to the end of the follow-up OHS improved and demonstrated continuous enhancement (* indicates P <0.005 for values in paired comparison with the preoperative OHS. A 0-100 OHS was used). (B) The general function of the hip is presented by a visual analog scale from 0 (worst) to 10 (best). Patients indicated improvement in function of the hip from day 10. (* indicates P <0.005 for values in paired comparison with the preoperative hip [visual analog scale]).
The general hip function was enhanced continuously from 4.0 ± 0.4 preoperatively to 8.0 ± 0.4 at day 31 after surgery (P <0.001; 100% statistical power) (Figure 2B). Ten days after the day of operation, statistical improvement was demonstrated (6.6 ± 0.4; P <0.001; 100% statistical power).
Fewer patients exceeded the HADS criteria in both the anxiety subscale (nine patients preoperatively compared with two patients 31 days postoperatively; P <0.001) and the depression subscale (five patients preoperatively compared with two patients 31 days postoperatively; P <0.001). HADS anxiety symptoms as well as HADS total score improved significantly 13 days postoperatively (67.3% statistical power) while HADS depression values were not improved until 25 days after surgery (40.8% statistical power) (Figure 3).
(Enlarge Image)
Figure 3.
(A) Hospital Anxiety and Depression Score (HADS) is illustrated as total HADS as well as the two sub-scores; HADS Anxiety and HADS Depression. During the observation period, reduction in all HADS-parameters were seen (* indicates P <0.005 for values in paired comparison with the preoperative values). (B) Frequency of patients (in percent of all included patients), who are above anxiety and depression cutoff criteria HADS Anxiety and Depression sub-score. (* indicates P <0.005 for values in paired comparison with the preoperative values).
Pain was decreased both at rest (4.3 ± 0.4 preoperatively compared with 1.4 ± 0.2 at 31 days postoperatively; P <0.001) and during activity (7.3 ± 0.3 preoperatively compared with 2.1 ± 0.3 at 31 days postoperatively; P <0.001; 100% statistical power) (Figure 4A). Pain scores during activity and at rest were improved after 1 and 4 days, respectively (100% and 74.9% statistical power). To this end, the patients' consumption of both nonprescription and prescription analgesics was increased during the first couple of weeks postoperatively (Figure 4B and C). At day 1 after surgery, 31 of 32 patients used nonprescription painkillers daily. A reduction in the number of patients who needed daily nonprescription analgesics was seen from day 13 compared with day 10 (P ¼0.008). At day 25, the number of patients taking nonprescription painkillers were similar to preoperative values (P ¼0.053) (Figure 4B).
(Enlarge Image)
Figure 4.
(A) Pain in rest and activity is illustrated as VAS 0 (no pain) – 10 (extremely painful) (* indicates P <0.005 for values in paired comparison with the preoperative pain values). (B) Patient consumption of nonpresciptive painkillers during the first month after total hip arthroplasty (THA) (* indicates P <0.005 for values in paired comparison with the preoperative values). (C) Patient consumption of prescriptive painkillers during the first month after THA (* indicates P <0.005 for values in paired comparison with the preoperative values).
Similarly, the intake of prescription analgesics was increased during the first 16 days postoperatively (Figure 4C). During the first day postoperatively, the number of patients taking prescription analgesics peaked at 97% (P <0.005). After 19 days, the number of patients who used prescription analgesics on a daily basis equaled the preoperative number of patients. During the rest of the observation period, most patients did not use prescription painkillers.
At 31 days postoperatively, the willingness to repeat treatment was 100%. Six percent of the patients would have had the surgery performed outpatient (discharged the same day as surgery).
Results
QOL
EQ5D improved from 0.63 ± 0.02 preoperatively to 0.78 ± 0.03 at 31 days postoperatively (P <0.001, 100% statistical power) (Figure 1A). From day 13 after surgery, EQ5D improved significantly compared to preoperative values (61.9% statistical power). In comparison, the norm of EQ5D index values for the Danish population (age-matched) is 0.883 for men and 0.818 for women. The comprehensive QoL improved from 6.6 ± 0.3 preoperatively to 7.8 ± 0.3 at day 31 (P <0.001, 93.6% statistical power) (Figure 1B).
(Enlarge Image)
Figure 1.
(A) European Quality of Life in Five Dimensions (EQ5D) demonstrated better quality of life from day 13 after total hip arthroplasty (THA) (*indicates P <0.005 for values in paired comparison with the preoperative EQ5D index). (B) The comprehensive quality of life was measured with a 0-10 visual analog scale, and demonstrated better overall quality of life at 31 days after THA (* indicates P <0.005 for values in paired comparison with the preoperative EQ5D index).
OHS
OHS improved from 49 ± 2.9 to 73 ± 5.4 (P <0.001; 100% statistical power) during the first month postoperatively (Figure 2A). As expected, OHS decreased at day 1 postoperatively (17 ± 1) compared to the preoperative value (49 ± 2.9) (P <0.001; 100% statistical power). From day 13 (28 ± 1; P ¼0.04) OHS improved increasingly throughout the follow-up (93.2% statistical power).
(Enlarge Image)
Figure 2.
(A) Oxford Hip Score (OHS) showed decreased function of the hip at day 1 after total hip arthroplasty (THA). From day 4 to 10 OHS was similar to the preoperative THA score. From day 13 and to the end of the follow-up OHS improved and demonstrated continuous enhancement (* indicates P <0.005 for values in paired comparison with the preoperative OHS. A 0-100 OHS was used). (B) The general function of the hip is presented by a visual analog scale from 0 (worst) to 10 (best). Patients indicated improvement in function of the hip from day 10. (* indicates P <0.005 for values in paired comparison with the preoperative hip [visual analog scale]).
The general hip function was enhanced continuously from 4.0 ± 0.4 preoperatively to 8.0 ± 0.4 at day 31 after surgery (P <0.001; 100% statistical power) (Figure 2B). Ten days after the day of operation, statistical improvement was demonstrated (6.6 ± 0.4; P <0.001; 100% statistical power).
HADS
Fewer patients exceeded the HADS criteria in both the anxiety subscale (nine patients preoperatively compared with two patients 31 days postoperatively; P <0.001) and the depression subscale (five patients preoperatively compared with two patients 31 days postoperatively; P <0.001). HADS anxiety symptoms as well as HADS total score improved significantly 13 days postoperatively (67.3% statistical power) while HADS depression values were not improved until 25 days after surgery (40.8% statistical power) (Figure 3).
(Enlarge Image)
Figure 3.
(A) Hospital Anxiety and Depression Score (HADS) is illustrated as total HADS as well as the two sub-scores; HADS Anxiety and HADS Depression. During the observation period, reduction in all HADS-parameters were seen (* indicates P <0.005 for values in paired comparison with the preoperative values). (B) Frequency of patients (in percent of all included patients), who are above anxiety and depression cutoff criteria HADS Anxiety and Depression sub-score. (* indicates P <0.005 for values in paired comparison with the preoperative values).
Pain and Analgesics
Pain was decreased both at rest (4.3 ± 0.4 preoperatively compared with 1.4 ± 0.2 at 31 days postoperatively; P <0.001) and during activity (7.3 ± 0.3 preoperatively compared with 2.1 ± 0.3 at 31 days postoperatively; P <0.001; 100% statistical power) (Figure 4A). Pain scores during activity and at rest were improved after 1 and 4 days, respectively (100% and 74.9% statistical power). To this end, the patients' consumption of both nonprescription and prescription analgesics was increased during the first couple of weeks postoperatively (Figure 4B and C). At day 1 after surgery, 31 of 32 patients used nonprescription painkillers daily. A reduction in the number of patients who needed daily nonprescription analgesics was seen from day 13 compared with day 10 (P ¼0.008). At day 25, the number of patients taking nonprescription painkillers were similar to preoperative values (P ¼0.053) (Figure 4B).
(Enlarge Image)
Figure 4.
(A) Pain in rest and activity is illustrated as VAS 0 (no pain) – 10 (extremely painful) (* indicates P <0.005 for values in paired comparison with the preoperative pain values). (B) Patient consumption of nonpresciptive painkillers during the first month after total hip arthroplasty (THA) (* indicates P <0.005 for values in paired comparison with the preoperative values). (C) Patient consumption of prescriptive painkillers during the first month after THA (* indicates P <0.005 for values in paired comparison with the preoperative values).
Similarly, the intake of prescription analgesics was increased during the first 16 days postoperatively (Figure 4C). During the first day postoperatively, the number of patients taking prescription analgesics peaked at 97% (P <0.005). After 19 days, the number of patients who used prescription analgesics on a daily basis equaled the preoperative number of patients. During the rest of the observation period, most patients did not use prescription painkillers.
Willingness to Repeat
At 31 days postoperatively, the willingness to repeat treatment was 100%. Six percent of the patients would have had the surgery performed outpatient (discharged the same day as surgery).
Source...