Singh JA, Lewallen D. Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty

Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, MN, USA.
Clinical Rheumatology (Impact Factor: 1.77). 08/2009; 28(12):1419-30. DOI: 10.1007/s10067-009-1267-z
Source: PubMed


To examine whether patient characteristics predict patient-reported pain and function 2- or 5-years after revision total hip arthroplasty (THA). In a prospective cohort of revision THA patients, we examined whether gender, age, body mass index (BMI), comorbidity (Deyo-Charlson index) and depression predicted moderate-severe hip pain, moderate-severe activity limitation (> or = 3 activities), dependence on walking aids and use of pain medications, using multivariable regression analysis. Significant predictors of moderate-severe pain at 2- and 5-years were [odds ratio (95% confidence interval)]: female gender, 1.3 (1.0, 1.6) and 1.5 (1.1, 1.9) and age 61-70, 0.7 (0.5, 1.0) and 0.7 (0.5, 1.0; reference (ref), < or = 60 years). BMI, 30-34.9, 1.4 (1.0, 1.9; ref BMI < or = 25) and depression, 1.6 (1.0, 2.5) were significantly associated with higher odds of moderate-severe pain at 2 years, but not at 5 years. Significant predictors of nonsteroidal anti-inflammatory drugs (NSAIDs) use 2-years post-revision THA were female gender, 1.4 (1.1, 1 .7), BMI, 30-34.9, 1.4 (1.0, 2.0) and age, 71-80, 0.7 (0.5, 0.9). At 5 years, female gender, 1.6 (1.2, 2.2) was significantly associated with NSAID use. Significant predictors of narcotic use 2-years post-revision THA were older age, 61-70, 0.5 (0.3, 0.7) and 71-80, 0.4 (0.3, 0.7) and depression, 2.4 (1.2, 4.6). At 5 years, women, had significantly higher odds 1.8 (1.1, 2.9) of narcotic use and those in age group 61-70 years, significantly lower odds of narcotic use, 0.4 (0.2, 0.7). Similarly, female gender, older age (>70) and BMI of 30 or higher were each significantly associated with higher odds of moderate-severe activity limitation at both, 2- and 5-years. Depression was associated with higher risk at 2 years, 1.7 (1.1, 2.6) and higher Deyo-Charlson score with a higher risk of moderate-severe activity limitation at 5 years, 1.7 (1.1, 2.7). Obesity and depression, considered modifiable clinical factors, were important independent predictors of pain, functional limitation and use of pain medications, following revision THA.

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Available from: Jasvinder A Singh
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    • "Second, this study adds significant validation data related to the construct validity of the Mayo hip score. Our finding of significant association of Mayo hip scores at 2-and 5-years with important baseline characteristics previously shown to impact pain and function outcomes, i.e. age, gender, BMI, ASA class and Deyo-Charlson index910111213141516, provides critical evidence for its convergent and divergent validity. The high correlation of Mayo hip score with HHS, a validated outcome instru- ment[19,20,22]and overall activity level, establishes the construct validity of Mayo hip score for assessment of outcomes after THA. "
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    ABSTRACT: Background Previous studies have provided the initial evidence for construct validity and test-retest reliability of the Mayo Hip Score. Instruments used for Total Hip Arthroplasty (THA) outcomes assessment should be valid, reliable and responsive to change. Our main objective was to examine the responsiveness to change, association with subsequent revision and the construct validity of the Mayo hip score. Methods Discriminant ability was assessed by calculating effect size (ES), standardized response mean (SRM) and Guyatt’s responsiveness index (GRI). Minimal clinically important difference (MCII) and moderate improvement thresholds were calculated. We assessed construct validity by examining association of scores with preoperative patient characteristics and correlation with Harris hip score, and assessed association of scores with the risk of subsequent revision. Results Five thousand three hundred seven provided baseline data; of those with baseline data, 2,278 and 2,089 (39 %) provided 2- and 5-year data, respectively. Large ES, SRM and GRI ranging 2.66–2.78, 2.42–2.61 and 1.67–1.88 were noted for Mayo hip scores with THA, respectively. The MCII and moderate improvement thresholds were 22.4–22.7 and 39.4–40.5 respectively. Hazard ratios of revision surgery were higher with lower final score or less improvement in Mayo hip score at 2-years and borderline significant/non-significant at 5-years, respectively: (1) score ≤55 with hazard ratios of 2.24 (95 % CI, 1.45, 3.46; p = 0.0003) and 1.70 (95 % CI, 1.00, 2.92; p = 0.05) of implant revision subsequently, compared to 72-80 points; (2) no improvement or worsening score with hazard ratios 3.94 (95 % CI, 1.50, 10.30; p = 0.005) and 2.72 (95 % CI, 0.85,8.70; p = 0.09), compared to improvement >50-points. Mayo hip score had significant positive correlation with younger age, male gender, lower BMI, lower ASA class and lower Deyo-Charlson index (p ≤ 0.003 for each) and with Harris hip scores (p < 0.001). Conclusions Mayo Hip Score is valid, sensitive to change and associated with future risk of revision surgery in patients with primary THA.
    Preview · Article · Dec 2016 · BMC Musculoskeletal Disorders
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    • "It is the most commonly used comorbidity measure in the medical literature and is associated with important outcomes such as mortality, hospitalization and outpatient utilization in populations similar to our cohort [22-24]. The presence of anxiety or depression was assessed based on the presence of the respective ICD-9-CM codes at the time of index TKA, as in previous studies [25-28]. "
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    ABSTRACT: To characterize whether medical comorbidities, depression and anxiety predict patient-reported functional improvement after total knee arthroplasty (TKA). We analyzed the prospectively collected data from the Mayo Clinic Total Joint Registry for patients who underwent primary or revision TKA between 1993-2005. Using multivariable-adjusted logistic regression analyses, we examined whether medical comorbidities, depression and anxiety were associated with patient-reported subjective improvement in knee function 2- or 5-years after primary or revision TKA. Odds ratios (OR), along with 95% confidence intervals (CI) and p-value are presented. We studied 7,139 primary TKAs at 2- and 4,234 at 5-years; similarly, 1,533 revision TKAs at 2-years and 881 at 5-years. In multivariable-adjusted analyses, we found that depression was associated with significantly lower odds of 0.5 (95% confidence interval [CI]: 0.3 to 0.9; p = 0.02) of 'much better' or 'better' knee functional status relative to same or worse status) 2 years after primary TKA. Higher Deyo-Charlson index was significantly associated with lower odds of 0.5 (95% CI: 0.2 to 1.0; p = 0.05) of 'much better' or 'better' knee functional status after revision TKA for every 5-point increase in score. Depression in primary TKA and higher medical comorbidity in revision TKA cohorts were associated with suboptimal improvement in index knee function. It remains to be seen whether strategies focused at optimization of medical comorbidities and depression pre- and peri-operatively may help to improve TKA outcomes. Study limitations include non-response bias and the use of diagnostic codes, which may be associated with under-diagnosis of conditions.".
    Full-text · Article · Apr 2014 · BMC Musculoskeletal Disorders
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    • "A recent study found that functional improvements were lower in patients with infection compared to patients with mechanical or pain causes for revision hip arthroplasty [5]. Other studies of predictors of outcomes after revision THA have reported the following variables to be associated: better preoperative pain scores and fewer comorbidities with functional outcomes [6]; higher comorbidity with major complications [7]; younger age, obesity and depression [8], higher body mass index (BMI) [9], and female gender with worse pain outcomes [4,8,10]; and higher BMI and worse preoperative scores with worse composite pain and function outcome [11]. "
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    ABSTRACT: To assess the association of operative diagnosis with patient-reported outcomes (PROs) after revision total hip arthroplasty (THA). We used prospectively collected data from the Mayo Clinic Total Joint Registry that collects pre- and post-operative pain and function outcomes using a validated Hip questionnaire, on all revision THAs from 1993-2005. We used logistic regression to assess the odds of moderate-severe index hip pain and moderate-severe limitation in activities of daily living (ADLs) 2- and 5-years after revision THA. We calculated odds ratios (OR) and 95% confidence intervals (CIs). For the 2- and 5-year cohorts, the operative diagnosis was loosening/wear/osteolysis in 73% and 75%; dislocation/bone or prosthesis fracture/instability or non-union in 17% and 15%; and failed prior arthroplasty with components removed/infection in 11% and 11%, respectively. In multivariable-adjusted analyses that included preoperative ADL limitations, compared to patients with loosening/wear/osteolysis, patients with dislocation/fracture/instability/non-union had OR of 2.2 (95% CI, 1.3-3.5; p=0.002) for overall moderate-severe ADL limitation and those with failed prior arthroplasty/infection had OR of 1.6 (95% CI, 1.0-2.8; p=0.06). At 5-years, ORs were lower and differences were no longer significant. Moderate-severe pain did not differ significantly by diagnosis, at 2- or 5-years in multivariable adjusted analyses, with one exception, i.e. failed prior arthroplasty/infection had a trend towards significance with odds ratio of 1.9 (95% CI, 0.9-3.8; p=0.07). Operative diagnosis is independently associated with ADL limitations, but not pain, at 2-years after revision THA. Patients should be informed of the risk of poorer short-term outcomes based on their diagnosis.
    Full-text · Article · Jul 2013 · BMC Musculoskeletal Disorders
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