Early Recovery Outcomes in Patients Undergoing Contemporary Posterior Approach Total Hip Arthroplasty: Each Week Shows Progress

Abstract

Background: Little is known about patients’ postoperative week-by-week progress after undergoing posterior approach total hip arthroplasty (THA) with regard to pain, function, return to work, and driving. Purpose: We sought to evaluate a large cohort of patients undergoing posterior approach THA with modified posterior hip precautions to better understand the trajectory of recovery. Methods: Patients at a single institution undergoing primary posterior approach THA by fellowship-trained arthroplasty surgeons were prospectively enrolled. Patient functional status and early rehabilitation recovery milestones were evaluated preoperatively and each week postoperatively for 6 weeks. Results: Of 312 patients who responded to weekly questionnaires, there were varying response rates per question. At 1 week after surgery, 15% (39/256) of respondents had returned to work, increasing to 57% (129/225) at week 6. At 6 weeks, 77% of patients (174/225) had returned to driving; 25% (56/225) were taking pain medication (including prescription opioids or nonsteroidal anti-inflammatory drugs); and 15% (34/225) were using assistive devices (down from 91%, 78%, 56%, 35%, and 27% at weeks 1, 2, 3, 4, and 5, respectively). Average postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement and Lower Extremity Functional Scale scores were significantly higher than preoperative scores. Respondents reported significantly less pain at each week postoperatively than the previous week. Conclusion: These findings suggest that there may be an expected pathway for recovery after posterior THA using perioperative pain protocols, modified postoperative precautions, and physical therapy protocols to improve patient outcomes after THA, with most patients returning to normal at 4 weeks. Defining the expected recovery timeline may help surgeons in counseling patients preoperatively and guiding their recovery.

Keywords

hip arthroplasty precautions posterior patient-reported outcomes

Get full access to this article

View all access options for this article.

References

Awad

Farley

Mostafa

Saleh

. Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty : a meta-analysis of functional outcomes and cost. Bone Joint J. 2021;103-B(6):1078–1087.

Barrett

Turner

Leopold

. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634–1638.

Bon

Kacem

Ben Lepretre

, et al. Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. Orthop Traumatol Surg Res. 2019;105(3):445–452.

Christensen

Jacobs

. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015;30:94–97.

Goeb

Krell

Nguyen

, et al. Early recovery outcomes in patients undergoing total hip arthroplasty through a posterior approach with modified postoperative precautions. J Arthroplasty. 2021;36(8):2817–2822.

Graves

Dropkin

Keeney

Lurie

JD.

Tomek

. Does surgical approach affect patient-reported function after primary THA? Clin Orthop Relat Res. 2016;474(4):971–981.

Higgins

Barlow

Heagerty

Lin

TJ.

. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015;30:419–434.

Hung

Bounsanga

Voss

Saltzman

. Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics. World J Orthop. 2018;9:41–49.

Kästner

Ng Kuet Leong

VSC

Petzke

, et al. The virtue of optimistic realism—expectation fulfillment predicts patient-rated global effectiveness of total hip arthroplasty. BMC Musculoskelet Disord. 2021;22:180.

10.

Klapwijk

LCM

Mathijssen

NMC

Van Egmond

Verbeek

Vehmeijer

SBW

. The first 6 weeks of recovery after primary total hip arthroplasty with fast track: a diary study of 94 patients. Acta Orthop. 2017;88(2):140–144.

11.

Luna

Kehlet

Peterson

Wede

Hoevsgaard

Aasvang

. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty. Bone Jt J. 2017;99-B:1167–1175.

12.

Lyman

Lee

Franklin

Mayman

Padgett

. Validation of the HOOS, JR: a short-form hip replacement survey. Clin Orthop Relat Res. 2016;474(6):1472–1482.

13.

Mancuso

Sculco

Salvati

. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty. 2003;18:872–878.

14.

Martusiewicz

Delagrammaticas

Harold

Bhatt

Beal

Manning

. Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period. HIP Int. 2020;30(6):695–702.

15.

McGonagle

Convery-Chan

DeCruz

Haebich

Fick

Khan

RJK

. Factors influencing return to work after hip and knee arthroplasty. J Orthop Traumatol. 2019;20:9.

16.

Mehta

Fulton

Quach

Thistle

Toledo

Evans

. Measurement properties of the lower extremity functional scale: a systematic review. J Orthop Sports Phys Ther. 2016;46:200–216.

17.

Moerenhout

Derome

Yves Laflamme

Leduc

Gaspard

Benoit

. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg. 2020;63(5):E412–E417.

18.

Moskal

. Anterior approach in THA improves outcomes: affirms. Orthopedics. 2011;34(9):e456–e458.

19.

Nelms

Birch

Halsey

Blankstein

McGinnis

Beynnon

. Assessment of early gait recovery after anterior approach compared to posterior approach total hip arthroplasty: a smartphone accelerometer–based study. J Arthroplasty. 2020;35(2):465–470.

20.

Peng

Zeng

Liu

Shen

. Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21(1):338.

21.

Schalet

Rothrock

Hays

, et al. Linking physical and mental health summary scores from the veterans RAND 12-Item Health Survey (VR-12) to the PROMIS® Global Health Scale. J Gen Intern Med. 2015;30:1524–1530.

22.

Tetreault

Akram

, et al. Are postoperative hip precautions necessary after primary total hip arthroplasty using a posterior approach? Preliminary results of a prospective randomized trial. J Arthroplasty. 2020;35:S246–S251.

23.

Tilbury

Schaasberg

Plevier

JWM

Fiocco

Nelissen

RGHH

Vliet Vlieland

TPM

. Return to work after total hip and knee arthroplasty: a systematic review. Rheumatol (United Kingdom). 2014;53:512–525.

24.

Weber

Zeman

Craiovan

, et al. Predicting outcome after total hip arthroplasty: the role of preoperative patient-reported measures. Biomed Res Int. 2019;2019:4909561.

25.

Yang

Huang

Sun

Yang

Deng

Tian

. Direct anterior approach versus posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis of randomized controlled studies. Orthop Surg. 2020;12(4):1065–1073.

26.

Zawadsky

Paulus

Murray

Johansen

. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty. 2014;29:1256–1260.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB

0.01 MB