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Does Implant Selection Affect Patient-Reported Outcome Measures After Primary Total Hip Arthroplasty?
Andrew Campbell1, Ahmed K Emara, Alison Klika
1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
The Journal of Bone and Joint Surgery. American Volume
|September 8, 2021
Summary
Total hip arthroplasty implant selection generally does not impact patient pain or function outcomes. Larger femoral heads may improve activity scores, but overall implant choice is not a key factor for successful total hip arthroplasty.
Area of Science:
- Orthopaedic surgery
- Biomedical engineering
- Clinical outcomes research
Background:
- Total hip arthroplasty (THA) is a common procedure, yet understanding the influence of surgical factors on patient-reported outcomes is crucial.
- Identifying specific implant characteristics that affect pain, function, and activity improvement is essential for optimizing THA results.
Purpose of the Study:
- To investigate whether the choice of femoral and acetabular components and bearing surfaces in THA influences patient outcomes.
- To determine the impact of implant selection on achieving adequate improvement in pain and function, substantial clinical benefit (SCB), and patient-acceptable symptomatic state (PASS).
Main Methods:
- Prospective data from 4,716 primary THA patients were analyzed, categorizing implants and assessing 1-year postoperative outcomes.
- Patient-reported outcome measures (PROMs), including the Hip disability and Osteoarthritis Outcome Score (HOOS) and UCLA activity score, were used.
- Inadequate improvement was defined using minimal clinically important difference (MCID) thresholds for HOOS and activity status for UCLA.
Main Results:
- No significant differences in achieving MCID for HOOS pain, HOOS physical function short form (PS), or UCLA activity scores were found across analyzed implant parameters.
- Implant selection was not a significant predictor of inadequate improvement in HOOS pain or HOOS PS.
- Larger (36-mm) femoral heads were associated with lower odds of inadequate improvement in UCLA activity scores compared to 28-mm heads (OR: 0.64, p=0.003).
- Implant characteristics did not significantly drive the attainment of PASS or SCB for HOOS pain.
Conclusions:
- THA implant characteristics, for the most part, do not significantly influence inadequate improvement in patient pain and function.
- Surgeons should prioritize implants with a proven track record, ensuring stable fixation and proper hip biomechanics restoration.
