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Outcomes/Effectiveness Research

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People who have more disability prior to hip replacement surgery have worse functioning and more pain after surgery

Individuals who need help with walking, housework, and grocery shopping or have other difficulties in functioning prior to hip replacement surgery are more likely to have poor functioning and pain up to a year after the surgery than those with better preoperative functioning. Patients and their doctors should consider these findings when discussing the timing of total hip replacement, suggest the University of Minnesota researchers who conducted the study. Their research was supported in part by the Agency for Healthcare Research and Quality (HS09735) and led by Jeremy Holtzman, M.D., M.S.

The researchers reviewed the medical records of 1,120 Medicare patients from 12 States who underwent total hip replacement for osteoarthritis during 1994 or 1995. They also surveyed the patients within 2 months and again 1 year after the procedure about their level of activity, presence and severity of pain with walking, need for help walking, distance they could walk, and whether they could perform daily activities such as housework and shopping. Almost all (95 percent) of the patients had moderate or severe pain with walking before surgery, and 81 percent could only walk less than 10 blocks. Almost half of the patients needed help with walking, housework, or shopping.

Patients who had pain when they walked prior to surgery were more likely to have pain 1 year after surgery than those who had no pain at baseline (21 vs. 9 percent). Patients who needed help with walking at baseline were more likely to need help 1 year after surgery than those who did not need assistance at baseline (38 vs. 15 percent). Similar results were seen with regard to the need for help with housework (39 vs. 18 percent) and grocery shopping (37 vs. 14 percent) and, to a lesser extent, for participation in moderate activity (17 vs. 10 percent). These results persisted, even after controlling for other medical problems such as heart or lung disease.

See "Effect of baseline functional status and pain on outcomes of total hip arthroplasty," by Dr. Holtzman, Khal Saleh, M.D., and Robert Kane, M.D., in the November 2002 Journal of Bone and Joint Surgery 84A(11), pp. 1942-1948.

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