Satisfaction rates, function, and return to activity following young adult total hip arthroplasty

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Abstract

Aims

Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures.

Methods

A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA.

Results

Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months.

Conclusion

Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes.

Cite this article: Bone Jt Open 2024;5(4):304–311.

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Most cited references 36

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The operation of the century: total hip replacement.

Ian Learmonth, Claire Young, Cecil Rorabeck (2007)

In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses. Both cemented and uncemented hips can provide durable fixation. Better materials and design have allowed use of large-bore bearings, which provide an increased range of motion with enhanced stability and very low wear. Minimally invasive surgery limits soft-tissue damage and facilitates accelerated discharge and rehabilitation. Short-term objectives must not compromise long-term performance. Computer-assisted surgery will contribute to reproducible and accurate placement of implants. Universal economic constraints in healthcare services dictate that further developments in total hip replacement will be governed by their cost-effectiveness.

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GRADING OF PATIENTS FOR SURGICAL PROCEDURES

Meyer Saklad (1941)

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Is Open Access

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

Mary E Charlson, Danilo Carrozzino, Jenny Guidi … (2022)

The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient’s unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.

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Author and article information

Contributors

Richard Galloway:

ORCID: https://orcid.org/0000-0002-7649-6861

Role: Registrar

Katie Monnington: Role: Physiotherapist

Rosalind Moss: Role: Clinical Lead Physiotherapist

James Donaldson: Role: Consultant

John Skinner: Role: Consultant

Robert McCulloch: Role: Consultant

Journal

Journal ID (nlm-ta): Bone Jt Open

Journal ID (iso-abbrev): Bone Jt Open

Journal ID (publisher-id): BJO

Title: Bone & Joint Open

Publisher: The British Editorial Society of Bone & Joint Surgery (London )

ISSN (Electronic): 2633-1462

Publication date (Electronic): 15 April 2024

Publication date Collection: April 2024

Volume: 5

Issue: 4

Pages: 304-311

Affiliations

[1 ] org-divisionDepartment of Orthopaedics , org-divisionDorset County Hospital , Dorchester, UK

[2 ] org-divisionDepartment of Orthopaedics , org-divisionRoyal National Orthopaedic NHS Trust , London, UK

Author notes

Correspondence should be sent to Richard Galloway. E-mail: rfgalloway@ 123456btinternet.com

J. Skinner discloses being an editorial board member of The Bone & Joint Journal, which is unrelated to this work. All other authors have no disclosures or conflicts of interest to declare.

Author information

Richard Galloway https://orcid.org/0000-0002-7649-6861

Article

Publisher ID: BJO-2024-0005.R1

DOI: 10.1302/2633-1462.54.BJO-2024-0005.R1

PMC ID: 11016360

SO-VID: 509b3e32-9bdc-44ab-a8c2-7d9811d91f3d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

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odf2nlm-version 2.0

price $2.00

principal-institution Royal National Orthopaedic Hospital, London, UK

article-type Hip

coi-statement J. Skinner discloses being an editorial board member of The Bone & Joint Journal, which is unrelated to this work. All other authors have no disclosures or conflicts of interest to declare.

Keywords: total hip arthroplasty,arthroplasty,young adults,quality of life,proms,total hip arthroplasty (tha),oxford hip score (ohs),developmental dysplasia of the hip (ddh),perthes’ disease,analgesia,narcotics,functional outcomes,cohort analysis,clinicians,femoroacetabular impingement

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Keywords: total hip arthroplasty, arthroplasty, young adults, quality of life, proms, total hip arthroplasty (tha), oxford hip score (ohs), developmental dysplasia of the hip (ddh), perthes’ disease, analgesia, narcotics, functional outcomes, cohort analysis, clinicians, femoroacetabular impingement

Satisfaction rates, function, and return to activity following young adult total hip arthroplasty

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Most cited references 36

The operation of the century: total hip replacement.

GRADING OF PATIENTS FOR SURGICAL PROCEDURES

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

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