Abstract
Introduction
The number of total hip arthroplasties (THAs) performed per year is increasing for reasons that are not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient health status as an indication for surgery and determine if patients are undergoing surgery at a better health status than in the past.
Methods
To examine how pre-operative functional health status has changed over time, a systematic review and meta-analysis of the Medline, Embase, and Cochrane databases was performed in accordance with the PRISMA guidelines. Health status was assessed using the physical component summary (PCS) score from the 36-item short-form (SF-36) health survey. Only primary procedures were included; revisions were excluded. Articles were screened by two independent reviewers with conflicts resolved by consensus with a third reviewer. Meta-regression analysis was performed to determine the effect of time, patient age, and gender. Subgroup analysis was performed to assess differences between countries.
Results
A total of 1,504 articles were identified. Data from 172 independent groups representing 18,644 patients recruited from 1990–2013 and identified from 107 articles were included in the final analysis. The mean pre-op PCS score was 31.2 (95% Confidence Interval: 30.5–31.9) with a 95% prediction interval of 22.6–39.8. The variance across studies was found to be statistically significant (p = 0.000) with 97.25% of this variance due to true variance. Neither year of enrolment, mean age, nor the percentage of females per group were found to have any significant effect. There were no significant differences between countries.
Conclusion
Patients are undergoing THA at a similar health status to the past. Patient age and gender do not influence the functional status at which patients are indicated for surgery. There are no significant regional differences in pre-op health status.
