Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: A follow-up study involving 61 patients

Abstract

Background and purpose Fast-track surgery has been reported to improve rehabilitation outcome after major surgery, with length of hospitalization and muscle strength as outcome measures. We assessed the effect of optimization of perioperative care during admission on self-reported functional outcome, and compared patient status 6 months after THR with an age-matched healthy cohort.

Patients and methods 79 THR patients were randomized to optimized perioperative care (OPC) or conventional perioperative care (CPC). 61 patients fulfilled the requirements of the study protocol. Endpoint outcome was measured by SF-36 and WOMAC. To compare functional outcome in the THR group with that in healthy controls, we used data from a representative sample of 4,098 non-institutionalized Danish adults collected by the Danish National Institute of Public Health.

Results We found similar improvements in SF-36 and WOMAC scores for the OPC and CPC groups postoperatively, except for the total WOMAC score and the WOMAC subscore "function"—in which the CPC group did statistically significantly better. The OPC and CPS groups had similar score levels. 6 months after surgery, THR patients scored higher overall in the general health subscale and lower in three physical subscales of SF-36 compared to age-matched healthy controls.

Interpretation We found no evidence for the effect of optimization strategies during admission on self-reported functional outcome after THR. Although THR patients improved considerably after treatment, their physical status remained below the level of the healthy controls. Our results may indicate that the potential for functional improvement in THR patients is not fully realized, but this must be studied further.

Contributions of authors

MP participated in the entire planning process and execution of the study, data collection, statistical analysis, and preparation of the manuscript. NA participated in the planning process and in the statistical analysis and preparation of the manuscript. KS performed many of the THRs and participated in the entire process, especially in preparation of the manuscript.

This project was supported by grants from "Forskningsini-tiativet Århus Amt" and the Society of Danish Physiotherapists.