QoL and Hip Function During the First Month After THA
QoL and Hip Function During the First Month After THA
Background: Fast-track surgery has been introduced for the treatment of patients receiving total hip arthroplasty. There is, however, a lack of knowledge on how well patients cope with the fast-track surgery set-up in relation to total hip arthroplasty.
Methods: In 32 primary total hip arthroplasties, patient reported outcome parameters were monitored preoperatively and prospectively during 31 days postoperatively.
Results: During the first month postoperatively, the Oxford Hip Score improved from49±2.9 to 73±5.4 (P <0.001). Pain decreased both at rest (4.3 ± 0.5 compared with 1.4 ± 0.2; P <0.001) and during activity (7.3 ± 0.3 compared with 2.1 ± 0.3; P <0.001). To this end, patients' daily use of prescribed analgesia increased by 11% compared with preoperative consumption and use of over-thecounter analgesia increased 21%. EQ5D index values improved from (0.63 ± 0.02 to 0.78 ± 0.03; P <0.001). Fewer patients exceeded the Hospital Anxiety and Depression Scale (HADS) criteria in both the anxiety subscale (9 compared with 2; P <0.001) and the depression subscale (5 compared with 2; P <0.001). Willingness to repeat treatment was 100%. Six percent of the patients could imagine the surgery being performed outpatient.
Conclusions: During the first month after total hip arthroplasty, the Oxford Hip Score, quality of life, and pain were improved. However, more patients needed analgesia at 1mo postoperatively. Patient satisfaction was high in our fast-track setup.
Hip osteoarthritis (OA) results in pain, disability, and loss of quality of life (QoL). Total hip arthroplasty (THA) is a successful procedure in treatment of OA. The increasing number of THAs during the next 2 decades is expected to continue, and the present economical costs related to arthroplasty surgery are massive. The limited healthcare budgets available are conflicting with the rising demand for THA, the paradox of which has resulted in attempts to decrease patient length of hospital stay (LOS) without compromising quality of treatment. In the United Kingdom, the average LOS after hip arthroplasty is 10.6 days, and in Denmark the national average is 7.4 days. Attention has been focused on optimizing perioperative logistical and clinical features to reduce postoperative convalescence. This methodology is called ''fast-track,'' and is multidisciplinary, involving patient information, analgesia, early mobilization, nutrition and physical training preoperatively and postoperatively.
Several studies have described reduction of perioperative morbidity, optimized anesthesiology procedures and pain management, and quick mobilization.
Hence, fast-track has been proven to be an efficient tool to reduce LOS in the orthopaedic ward. Little attention, however, has been given to how patients cope with the principles of fast-track surgery. Some results might suggest a need for more preoperative or early postoperative (3mo) physical intervention. Subacute postoperative comfort, quality of life, pain, and functional ability after discharge from the hospital remains incompletely described in relation to fast-track hip arthroplasty. Therefore, we have conducted a prospective study describing these topics during the first 31 days after THA in a well-defined fast-track setup.
Abstract and Introduction
Abstract
Background: Fast-track surgery has been introduced for the treatment of patients receiving total hip arthroplasty. There is, however, a lack of knowledge on how well patients cope with the fast-track surgery set-up in relation to total hip arthroplasty.
Methods: In 32 primary total hip arthroplasties, patient reported outcome parameters were monitored preoperatively and prospectively during 31 days postoperatively.
Results: During the first month postoperatively, the Oxford Hip Score improved from49±2.9 to 73±5.4 (P <0.001). Pain decreased both at rest (4.3 ± 0.5 compared with 1.4 ± 0.2; P <0.001) and during activity (7.3 ± 0.3 compared with 2.1 ± 0.3; P <0.001). To this end, patients' daily use of prescribed analgesia increased by 11% compared with preoperative consumption and use of over-thecounter analgesia increased 21%. EQ5D index values improved from (0.63 ± 0.02 to 0.78 ± 0.03; P <0.001). Fewer patients exceeded the Hospital Anxiety and Depression Scale (HADS) criteria in both the anxiety subscale (9 compared with 2; P <0.001) and the depression subscale (5 compared with 2; P <0.001). Willingness to repeat treatment was 100%. Six percent of the patients could imagine the surgery being performed outpatient.
Conclusions: During the first month after total hip arthroplasty, the Oxford Hip Score, quality of life, and pain were improved. However, more patients needed analgesia at 1mo postoperatively. Patient satisfaction was high in our fast-track setup.
Introduction
Hip osteoarthritis (OA) results in pain, disability, and loss of quality of life (QoL). Total hip arthroplasty (THA) is a successful procedure in treatment of OA. The increasing number of THAs during the next 2 decades is expected to continue, and the present economical costs related to arthroplasty surgery are massive. The limited healthcare budgets available are conflicting with the rising demand for THA, the paradox of which has resulted in attempts to decrease patient length of hospital stay (LOS) without compromising quality of treatment. In the United Kingdom, the average LOS after hip arthroplasty is 10.6 days, and in Denmark the national average is 7.4 days. Attention has been focused on optimizing perioperative logistical and clinical features to reduce postoperative convalescence. This methodology is called ''fast-track,'' and is multidisciplinary, involving patient information, analgesia, early mobilization, nutrition and physical training preoperatively and postoperatively.
Several studies have described reduction of perioperative morbidity, optimized anesthesiology procedures and pain management, and quick mobilization.
Hence, fast-track has been proven to be an efficient tool to reduce LOS in the orthopaedic ward. Little attention, however, has been given to how patients cope with the principles of fast-track surgery. Some results might suggest a need for more preoperative or early postoperative (3mo) physical intervention. Subacute postoperative comfort, quality of life, pain, and functional ability after discharge from the hospital remains incompletely described in relation to fast-track hip arthroplasty. Therefore, we have conducted a prospective study describing these topics during the first 31 days after THA in a well-defined fast-track setup.
Source...