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Published on: February 27, 2018
Impact of preoperative factors on clinical outcomes after total hip arthroplasty
Toru Nishiwaki1, Hisatoshi Ishikura2, Yuji Masuyama2
1Department of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka 420-0853, Japan. tornish@gmail.com.
Insights
Preoperative central sensitization and psychological factors significantly impact total hip arthroplasty (THA) outcomes. Assessing these patient-specific traits is crucial for better recovery after THA surgery.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Rehabilitation Medicine
Background:
- Total hip arthroplasty (THA) is a common procedure for advanced hip disorders.
- However, functional improvements after THA vary among patients.
Purpose of the Study:
- To identify preoperative factors influencing clinical outcomes following THA.
- Investigate the role of pain, psychological status, and central sensitization.
Main Methods:
- Retrospective analysis of 411 unilateral THA patients.
- Evaluated associations between preoperative factors and 6-month postoperative outcomes (WOMAC, mHHS).
- Included assessment of age, BMI, pain, depression, neuropathic pain, and central sensitization.
Main Results:
- Age, WOMAC, CES-D, and CSI scores predicted modified Harris Hip Score.
- Age, WOMAC, EQ-5D, CES-D, CSI, and Pain Detect predicted WOMAC scores.
- Age, WOMAC, and CSI were consistent predictors across outcomes.
Conclusions:
- Preoperative assessment of central sensitization and psychological factors is vital.
- Patient-specific preoperative characteristics are key determinants of THA recovery.
- These factors may be more influential than intraoperative variables.
Background:
Although total hip arthroplasty (THA) is an established intervention for advanced hip disorders, not all patients achieve the anticipated functional improvements.
Aim:
To investigate the impact of various preoperative factors on clinical outcomes after THA.
Methods:
Data of 411 patients who underwent unilateral THA were retrospectively analyzed. The associations between preoperative factors, such as age, body mass index, pain severity, functional impairment, psychological status, neuropathic pain, and central sensitization, and clinical outcomes assessed six months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and modified Harris Hip Score were evaluated.
Results:
Our results indicated that age and the WOMAC, Center for Epidemiologic Studies Depression Scale, and Central Sensitization Index (CSI) scores significantly predicted the modified Harris Hip Score outcomes, whereas age and preoperative WOMAC, EuroQol 5 dimensions, Center for Epidemiologic Studies Depression Scale, CSI, and Pain Detect Questionnaire scores were significant predictors of WOMAC outcomes. Age, WOMAC, and CSI were consistently significant factors. There were no significant differences in the operative time or blood loss across the outcome categories.
Conclusion:
Our findings highlight the importance of preoperative assessment of central sensitization and psychological parameters. Patient-specific preoperative characteristics may play a greater role than intraoperative factors in determining recovery outcomes after THA.
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