Is There Agreement Between Clinical Outcomes as Perceived by the Surgeon and the Patient in Revision Total Hip Arthroplasty?

TL;DR

This study examines whether surgeons and patients agree on the outcomes of hip revision surgery, finding some alignment but also key differences in perceived results.

Contribution

The study provides new insights into the agreement between surgeon and patient perspectives on outcomes in revision total hip arthroplasty.

Findings

Surgeons and patients showed agreement in outcomes measured by HHS, SF-12, and WOMAC.

Patients revised for infection or dislocation reported worse outcomes than surgeons perceived.

Multiple revision surgeries and higher anesthetic risk correlated with poorer patient-reported outcomes.

Abstract

Objectives: Revision total hip arthroplasty (rTHA) is a complex surgery with variable functional outcomes that often differ between the surgeon’s perception and the patient’s experience. Therefore, the aim of this study is, first, to evaluate functional outcomes based on the reason for revision, type of revision, acetabular defect, and number of prior revision surgeries; and second, to compare outcomes from both the surgeon’s and the patient’s perspectives to determine whether or not there is agreement between them. Materials and Methods: An observational study was conducted on patients who underwent rTHA at a tertiary-level center from January 2013 to December 2018, with a median follow-up of 41 months. A total of 149 procedures were performed during this period. The variables analyzed included the indication for revision surgery, type of revision, presence of acetabular defect, and number of previous revision surgeries. The surgeon’s perspective was assessed using the Harris Hip Score (HHS), while the patient’s perspective was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-12 Health Survey (SF-12). Results: Analysis of the variables from both surgeon’s and patient’s perspectives showed statistically significant differences regarding the indication for revision and the SF-12 component, with patients undergoing revision for infection or dislocation reporting worse functional outcomes. Although the remaining variables did not reach statistical significance, the surgeon perceived worse outcomes in patients revised for infection and in those who underwent revision of both components (acetabular and femoral). Conversely, patients reported poorer functional outcomes when operated on for infection or dislocation, when both components were revised, and when they had undergone more than one revision surgery. Additionally, a statistically significant trend was observed showing worse outcomes with increasing anesthetic risk. Linear regression analysis between the surgeon’s evaluation and the patient-reported outcome measures showed a statistically significant association, indicating that higher surgeon scores correlated with fewer symptoms and better hip function as reported by patients. Conclusion: There was concordance between the surgeon’s evaluation, measured by the Harris Hip Score (HHS), and the patient’s perception of health status through PROMs, specifically the SF-12 and WOMAC questionnaires. Although overall results were satisfactory regardless of the reason for the revision, type of revision, defect grade, or number of revisions; outcomes were slightly worse in patients revised for dislocation or infection, those undergoing revisions of both components, and in cases involving multiple revision surgeries.

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