Abstract
Introduction
Patients who undergo hip resurfacing, total hip arthroplasty (THA), and total knee arthroplasty (TKA) are frequently assessed post-operatively using objective scoring indices. A small yet significant percentage of these patients report specific unfulfilled functions following surgery, indicating unmet expectations. The purpose of this study was to examine the types of functional deficits reported for each class of surgery, how frequently these limitations occur, and the demographic of patients who experience/report these limitations.
Methods
Four groups of subjects were enrolled in this study: (i) 111 hip resurfacing patients at an average of 14 months after resurfacing, (ii) 170 patients at an average of 16 months post-primary THA, (iii) 61 patients at an average of 12 months post-primary TKA, and (iv) 64 control subjects with no history of hip or knee surgery or pathology. Each participant completed a self-administered Hip Function Questionnaire, Knee Function Questionnaire, or Hip Resurfacing Questionnaire which assessed each subject's overall satisfaction and expectations following surgery. The questionnaires included numerical scores of post-operative function as well as an open-ended question which inquired “Is there anything your knee/hip keeps you from doing?”
Results
A population of patients self-reported specific functional deficits after surgery, including 29 (26.1%) resurfacing, 5 (2.9%) THA, and 32 (52.5%) TKA. The unfulfilled functions varied based on the procedure, with most resurfacing and THA patients reporting trouble with running/jogging, while TKA patients experienced difficulty kneeling. Patients who reported functional deficits also tended to endorse lower overall satisfaction levels after surgery; the mean satisfaction score for hip resurfacing in those who reported deficits was 4.03 (scale of 1–5) versus 4.50 (p=0.09) in those who denied a functional deficit, 2.20 versus 4.47 (p=0.003) in THA patients, and 4.10 versus 4.36 (p=0.35) in TKA patients. The demographic of patients who reported limitations varied based on the type of surgery. After hip resurfacing 19.0% (4/21) of female patients reported specific deficits compared to 27.3% (23/84) of male patients; 6.1% (5/81) of female THA patients reported compared to 0% (0/84) of males, and 48.6% (18/37) of female TKA patients reported compared to 58.3% (14/24) of males. The mean age of those who reported deficits versus those who did not report deficits was not significant.
Conclusions
Despite advances in arthroplasty and resurfacing techniques, a significant portion of patients are experiencing functional limitations following hip resurfacing, TKA, and THA procedures. The frequency and types of limitations reported vary based on the surgery, with TKA patients reporting deficits with the highest frequency and THA patients reporting with the lowest frequency. The gender of the patient appears to play a role in whether specific functional deficits are reported or not, with female patients more likely to report after THA and male patients slightly more likely to report after either hip resurfacing or TKA.
Summary
A small portion of hip resurfacing, THA, and TKA patients report specific unfulfilled functions following surgery. The frequency and types of deficits, and the demographic of patients reporting them, varies based on the procedure.
