Patients with multiple sclerosis have higher rates of worsening following total hip arthroplasty: a propensity-matched analysis

Abstract

Introduction:

The progressive nature of multiple sclerosis (MS) may adversely affect outcomes following total hip arthroplasty (THA). As patient-reported outcome measures (PROMs) in this specific group are not well defined, this study aimed to compare the clinical outcomes and the rates of achieving the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) between patients with MS and those without MS undergoing THA.

Methods:

We conducted a retrospective analysis of 375 THAs, including 75 MS patients and 300 propensity-matched non-MS patients (4:1), performed between 2016 and 2022. Collected PROMs included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10-a (PF-10a), and Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). Preoperative and postoperative PROMs and MCID-I/MCID-W rates were compared.

Results:

A total of 375 THAs, including 75 MS and 300 matched non-MS patients, were analysed. MS patients had higher 90-day postoperative complication rates (9.3% vs. 2.3%, p = 0.012) and infection rates (4.0% vs. 0.3%, p = 0.006). The rates of achieving MCID-I and MCID-W were similar for PROMIS Global Mental, PROMIS Global Physical, and HOOS-PS, but MS patients had a higher rate of experiencing MCID-W for PROMIS PF-10a compared to non-MS patients (16.7% vs. 6.5%, p = 0.022). Additionally, MS patients had a longer mean hospital stay (2.4 vs. 1.9 days, p = 0.005) and lower rates of being discharged home (82.7% vs. 94.3%, p < 0.001).

Conclusions:

The present study found that MS patients experience similar rates of MCID-I and MCID-W in most PROMs but have a higher rate of MCID-W for PROMIS PF-10a and increased postoperative complications. These findings highlight the need for careful consideration of postoperative risks despite potential improvements. Further research is needed to explore the impact of MS progression on PROMs and perioperative outcomes.

Keywords

MCID multiple sclerosis outcomes. PROMs total hip arthroplasty

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References

Learmonth

Young

Rorabeck

The operation of the century: total hip replacement. Lancet 2007; 370: 1508–1519.

Podmore

Hutchings

van der Meulen

, et al. Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open 2018; 8: e021784.

Mai

Blackowicz

Kister

, et al. The outcomes of total hip arthroplasty in patients with and without multiple sclerosis: a retrospective cohort study. Hip Int 2023; 33: 604–610.

McGinley

Goldschmidt

Rae-Grant

AD.

Diagnosis and treatment of multiple sclerosis: a review. JAMA 2021; 325: 765–779.

Marcus

What is multiple sclerosis?

JAMA 2022; 328: 2078.

Cheng

Mao

Hao

Multiple sclerosis is associated with adverse outcomes following hip and knee arthroplasty: a systematic review and meta-analysis of observational studies. Mult Scler Relat Disord 2023; 79: 104956.

Marrie

Reider

Stuve

, et al. The incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21: 332–341.

Berrigan

Fisk

Patten

, et al. Health-related quality of life in multiple sclerosis: Direct and indirect effects of comorbidity. Neurology 2016; 86: 1417–1424.

Cichos

Lehtonen

McGwin

, et al. Inhospital complications of patients with neuromuscular disorders undergoing total joint arthroplasty. J Am Acad Orthop Surg 2019; 27: e535–e543.

10.

Ross

Lee

, et al. Osteoporosis management and secondary fragility fracture rates in patients with multiple sclerosis: a matched cohort study. Osteoporos Int 2022; 33: 1999–2010.

11.

Tan

Kasliwal

Muth

, et al. Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis? J Clin Neurosci 2014; 21: 2189–2193.

12.

Kamalapathy

Bell

Puvanesarajah

, et al. Postoperative outcomes following posterior lumbar fusion in patients with multiple sclerosis. Clin Spine Surg 2022; 35: E211–E215.

13.

Quinlan

Chen

Werner

, et al. Patients with multiple sclerosis are at increased risk for postoperative complications following total hip and knee arthroplasty. J Arthroplasty 2019; 34: 1606–1610.

14.

Rondon

Schlitt

Tan

, et al. Survivorship and outcomes in patients with multiple sclerosis undergoing total joint arthroplasty. J Arthroplasty 2018; 33: 1024–1027.

15.

Gutman

Kim

Schwarzkopf

, et al. Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis. Int J MS Care 2018; 20: 244–250.

16.

Humphrey

Katakam

Melnic

, et al. Defining failure in primary total joint arthroplasty: the minimal clinically important difference for worsening score. J Arthroplasty 2022; 37: 630–636.e1.

17.

Black

Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167.

18.

Cella

Riley

Stone

, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 2010; 63: 1179–1194.

19.

Khalil

Darrith

Franovic

, et al. Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Forms demonstrate responsiveness in patients undergoing knee arthroplasty. J Arthroplasty 2020; 35: 1540–1544.

20.

Rose

Bjorner

Becker

, et al. Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61: 17–33.

21.

Hays

Bjorner

Revicki

, et al. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18: 873–880.

22.

Canfield

Savoy

Cote

, et al. Patient-reported outcome measures in total joint arthroplasty: defining the optimal collection window. Arthroplast Today 2019; 6: 62–67.

23.

Katakam

Florissi

Colon Iban

, et al. Class III obesity increases risk of failure to achieve the 1-year Hip disability and Osteoarthritis Outcome Score-Physical Function Short Form minimal clinically important difference following total hip arthroplasty. J Arthroplasty 2021; 36: 187–192.

24.

Katakam

Collins

Sauder

, et al. Obesity increases risk of failure to achieve the 1-year PROMIS PF-10a minimal clinically important difference following total joint arthroplasty. J Arthroplasty 2021; 36(7S): S184–S191.

25.

Salimy

Paschalidis

Dunahoe

, et al. Patient-reported outcomes following revision total hip arthroplasty demonstrate less improvement and significantly higher rates of worsening compared to primaries. J Arthroplasty 2023; 38: 2410–2414.

26.

Rojanasopondist

Galea

Connelly

, et al. What preoperative factors are associated with not achieving a minimum clinically important difference after THA? Findings from an international multicenter study. Clin Orthop Relat Res 2019; 477: 1301–1312.

27.

Newman

Naziri

Chughtai

, et al. Does multiple sclerosis affect the inpatient perioperative outcomes after total hip arthroplasty? J Arthroplasty 2017; 32: 3669–3674.

28.

Newman

Khlopas

Sodhi

, et al. Are adverse outcome rates higher in multiple sclerosis patients after total hip arthroplasty? Bone Joint J 2018; 100-B: 875–881.

29.

Duan

Jing

, et al. Rehabilitation treatment of multiple sclerosis. Front Immunol 2023; 14: 1168821.

30.

Ward

Suh

Lane

, et al. Body composition and physical function in women with multiple sclerosis. J Rehabil Res Dev 2013; 50: 1139–1147.

31.

Kołtuniuk

Pawlak

Krówczyńska

, et al. The quality of life in patients with multiple sclerosis – association with depressive symptoms and physical disability: a prospective and observational study. Front Psychol 2023; 13: 1068421.

32.

Chen

Liu

Sun

, et al. Effectiveness and neural mechanisms of home-based telerehabilitation in patients with stroke based on fMRI and DTI. Medicine (Baltimore) 2018; 97: e9605.

33.

Salari

Hayati

Kazeminia

, et al. The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: a systematic review and meta-analysis of clinical trials. Neurol Sci 2022; 43: 167–185.

34.

Gustavsen

Olsson

Søndergaard

, et al. The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey. BMC Neurol 2021; 21: 317.

35.

Filippi

Bar-Or

Piehl

, et al. Multiple sclerosis. Nat Rev Dis Primers 2018; 4: 43.