Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

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 (≥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), ≤ 60 years). BMI, 30–34.9, 1.4 (1.0, 1.9; ref BMI ≤ 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785

    Article  PubMed  Google Scholar 

  2. Best JT (2005) Revision total hip and total knee arthroplasty. Orthop Nurs 24:174–179 quiz 80–1

    Article  PubMed  Google Scholar 

  3. Lubbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P (2007) Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 57:327–334

    Article  PubMed  Google Scholar 

  4. Saleh KJ, Celebrezze M, Kassim R, Dykes DC, Gioe TJ, Callaghan JJ, Salvati EA (2003) Functional outcome after revision hip arthroplasty: a metaanalysis. Clin Orthop Relat Res 416:254–264

    Article  PubMed  Google Scholar 

  5. Bohm P, Bischel O (2004) The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res 420:148–159

    Article  PubMed  Google Scholar 

  6. Dearborn JT, Harris WH (2000) Acetabular revision after failed total hip arthroplasty in patients with congenital hip dislocation and dysplasia. Results after a mean of 8.6 years. J Bone Joint Surg Am 82-A:1146–1153

    CAS  PubMed  Google Scholar 

  7. Haddad FS, Garbuz DS, Masri BA, Duncan CP (2000) Structural proximal femoral allografts for failed total hip replacements: a minimum review of five years. J Bone Joint Surg Br 82:830–836

    Article  CAS  PubMed  Google Scholar 

  8. Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur: a critical analysis. Clin Orthop Relat Res 371:98–107

    Article  PubMed  Google Scholar 

  9. Radcliffe GS, Tomichan MC, Andrews M, Stone MH (1999) Revision hip surgery in the elderly: is it worthwhile? J Arthroplasty 14:38–44

    Article  CAS  PubMed  Google Scholar 

  10. van Biezen FC, ten Have BL, Verhaar JA (2000) Impaction bone-grafting of severely defective femora in revision total hip surgery: 21 hips followed for 41–85 months. Acta Orthop Scand 71:135–142

    Article  PubMed  Google Scholar 

  11. Biring GS, Masri BA, Greidanus NV, Duncan CP, Garbuz DS (2007) Predictors of quality of life outcomes after revision total hip replacement. J Bone Joint Surg Br 89:1446–1451

    Article  CAS  PubMed  Google Scholar 

  12. Davis AM, Agnidis Z, Badley E, Kiss A, Waddell JP, Gross AE (2006) Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am 88:685–691

    Article  PubMed  Google Scholar 

  13. Espehaug B, Havelin LI, Engesaeter LB, Langeland N, Vollset SE (1998) Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop Relat Res 351:135–148

    Article  PubMed  Google Scholar 

  14. Lubbeke A, Moons KG, Garavaglia G, Hoffmeyer P (2008) Outcomes of obese and nonobese patients undergoing revision total hip arthroplasty. Arthritis Rheum 59:738–745

    Article  PubMed  Google Scholar 

  15. Jain R, Schemitsch EH, Waddell JP (2000) Functional outcome after acetabular revision with roof reinforcement rings. Can J Surg 43:276–282

    CAS  PubMed  Google Scholar 

  16. Jain R, Schemitsch EH, Waddell JP (2000) Cementless acetabular revision arthroplasty. Can J Surg 43:269–275

    CAS  PubMed  Google Scholar 

  17. Lingard EA, Riddle DL (2007) Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am 89:1161–1169

    Article  PubMed  Google Scholar 

  18. Brander V, Gondek S, Martin E, Stulberg SD (2007) Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 464:21–26

    PubMed  Google Scholar 

  19. Kavanagh BF, Fitzgerald RH Jr (1985) Clinical and roentgenographic assessment of total hip arthroplasty: a new hip score. Clin Orthop Relat Res 193:133–140

    PubMed  Google Scholar 

  20. McGrory BJ, Morrey BF, Rand JA, Ilstrup DM (1996) Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 11:47–57

    Article  CAS  PubMed  Google Scholar 

  21. Rand JA, Ilstrup DM (1991) Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am 73:397–409

    CAS  PubMed  Google Scholar 

  22. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85-A:259–265

    PubMed  Google Scholar 

  23. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  24. Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M (2007) Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 465:185–188

    PubMed  Google Scholar 

  25. Singh JA, Gabriel S, Lewallen D (2008) The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res 466:2717–2723

    Article  PubMed  Google Scholar 

  26. WHO (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva

    Google Scholar 

  27. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  28. Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG Jr (1987) Morbidity during hospitalization: can we predict it? J Chronic Dis 40:705–712

    Article  CAS  PubMed  Google Scholar 

  29. Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266

    CAS  PubMed  Google Scholar 

  30. Weaver F, Hynes D, Hopkinson W, Wixson R, Khuri S, Daley J, Henderson WG (2003) Preoperative risks and outcomes of hip and knee arthroplasty in the Veterans Health Administration. J Arthroplasty 18:693–708

    Article  PubMed  Google Scholar 

  31. Zeger SL, Liang KY, Albert PS (1988) Models for longitudinal data: a generalized estimating equation approach. Biometrics 44:1049–1060

    Article  CAS  PubMed  Google Scholar 

  32. Asch DA, Jedrziewski MK, Christakis NA (1997) Response rates to mail surveys published in medical journals. J Clin Epidemiol 50:1129–1136

    Article  CAS  PubMed  Google Scholar 

  33. Franklin PD, Li W, Ayers DC (2008) The Chitranjan Ranawat Award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res 466:2597–2604

    Article  PubMed  Google Scholar 

  34. Berry DJ, Kessler M, Morrey BF (1997) Maintaining a hip registry for 25 years: Mayo Clinic experience. Clin Orthop Relat Res 344:61–68

    Article  PubMed  Google Scholar 

  35. Kavanagh BF, Ilstrup DM, Fitzgerald RH Jr (1985) Revision total hip arthroplasty. J Bone Joint Surg Am 67:517–526

    CAS  PubMed  Google Scholar 

  36. McDonald DJ, Sim FH (1987) Total hip arthroplasty in Paget’s disease. A follow-up note. J Bone Joint Surg Am 69:766–772

    CAS  PubMed  Google Scholar 

  37. Singh J, Gabriel S, Lewallen D (2007) Age and gender are predictors of moderate or severe pain post Total Knee Arthroplasty (TKA). Arthritis Rheum

  38. Trief PM, Ploutz-Snyder R, Fredrickson BE (2006) Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine 31:823–830

    Article  PubMed  Google Scholar 

  39. Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN (2002) The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29:1273–1279

    PubMed  Google Scholar 

  40. Chrischilles EA, Lemke JH, Wallace RB, Drube GA (1990) Prevalence and characteristics of multiple analgesic drug use in an elderly study group. J Am Geriatr Soc 38:979–984

    CAS  PubMed  Google Scholar 

  41. Henderson S, Lewis IC, Howell RH, Rayner KJ (1981) Mental health and the use of alcohol, tobacco, analgesics, and vitamins in a secondary school population. Acta Psychiatr Scand 63:186–189

    Article  CAS  PubMed  Google Scholar 

  42. Jacobsen BK, Hansen V (1989) Mental problems and frequent use of analgesics. Lancet 1:273

    Article  CAS  PubMed  Google Scholar 

  43. Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36

    Article  PubMed  Google Scholar 

  44. Montin L, Leino-Kilpi H, Katajisto J, Lepisto J, Kettunen J, Suominen T (2007) Anxiety and health-related quality of life of patients undergoing total hip arthroplasty for osteoarthritis. Chronic Illn 3:219–227

    Article  PubMed  Google Scholar 

  45. Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342:1016–1022

    Article  CAS  PubMed  Google Scholar 

  46. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 287:337–344

    Article  PubMed  Google Scholar 

  47. Antonov K, Isacson D (1996) Use of analgesics in Sweden–the importance of sociodemographic factors, physical fitness, health and health-related factors, and working conditions. Soc Sci Med 42:1473–1481

    Article  CAS  PubMed  Google Scholar 

  48. O’Connor MI (2007) Sex differences in osteoarthritis of the hip and knee. J Am Acad Orthop Surg 15(Suppl 1):S22–S25

    PubMed  Google Scholar 

  49. Zhang Y, Jordan JM (2008) Epidemiology of osteoarthritis. Rheum Dis Clin North Am 34:515–529

    Article  PubMed  Google Scholar 

  50. Kim Y, Morshed S, Joseph T, Bozic K, Ries MD (2006) Clinical impact of obesity on stability following revision total hip arthroplasty. Clin Orthop Relat Res 453:142–146

    Article  PubMed  Google Scholar 

  51. Vincent HK, Weng JP, Vincent KR (2007) Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty. Obesity (Silver Spring) 15:522–530

    Article  Google Scholar 

  52. Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD (2005) Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res 435:232–238

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Youlonda Lochler for assistance in data extraction, Megan O’Byrne in data programming and analysis, and Scott Harmsen in data analysis.

Disclosures

There are no financial conflicts related to this work. One of the authors (DL) has received royalties/speaker fees from Zimmer, has been a paid consultant to Zimmer, and has received institutional research funds from DePuy, Stryker and Zimmer.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Author information

Authors and Affiliations

  1. Departments of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, MN, USA

    Jasvinder A. Singh

  2. Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA

    Jasvinder A. Singh & David Lewallen

  3. Rheumatology Section, Medicine Service, VA Medical Center, Minneapolis, MN, USA

    Jasvinder A. Singh

  4. Division of Rheumatology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Jasvinder A. Singh

  5. Rheumatology (111R), Minneapolis VA Medical Center, One Veteran’s Drive, Minneapolis, MN, 55417, USA

    Jasvinder A. Singh

Authors
  1. Jasvinder A. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Lewallen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jasvinder A. Singh.

Additional information

Grant support: NIH CTSA award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research) and the Department of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, J.A., Lewallen, D. Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol 28, 1419–1430 (2009). https://doi.org/10.1007/s10067-009-1267-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-009-1267-z

Keywords

Search

Navigation