Although a few studies have assessed cosmetic outcomes following total hip arthroplasty (THA), none have investigated their association with hip-specific patient-reported outcome measures (PROMs). This study aimed to investigate the relationship between cosmetic outcomes and PROMs following THA.
Methods:
We included 139 cases of primary THAs for osteoarthritis of the hip with a follow-up period of at least 1 year. Cosmetic outcomes were evaluated using the Patient Scar Assessment Scale (PSAS) from the Patient and Observer Scar Assessment Scale. PROMs were assessed using the Forgotten Joint Score-12 (FJS-12) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Correlations between cosmetic outcomes and PROMs were analysed.
Results:
The mean follow-up period after THA was 24 months. The PSAS total score was negatively correlated with the FJS-12 total score (r = −0.430, p < 0.001) and JHEQ total score (r = −0.243, p = 0.004). Among the JHEQ subscales, negative correlations were observed with the pain (r = −0.221, p = 0.009) and mental (r = −0.288, p < 0.001) subscales.
Conclusions:
Better cosmetic outcomes were associated with better PROMs after THA. However, the direction and clinical importance of the association remain unclear and warrant further investigation.
YanLGeLDongS, et al. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: a systematic review and network meta-analysis. JAMA Netw Open2023; 6: e2253942.
2.
LanRHBellJWSamuelLT, et al. Outcome measures in total hip arthroplasty: have our metrics changed over 15 years?Arch Orthop Trauma Surg2022; 142: 1753–1762.
3.
AggarwalANaylorJMAdieS, et al. Preoperative factors and patient-reported outcomes after total hip arthroplasty: multivariable prediction modeling. J Arthroplasty2022; 37: 714–720.e4.
4.
GaleaVPRojanasopondistPIngelsrudLH, et al. Longitudinal changes in patient-reported outcome measures following total hip arthroplasty and predictors of deterioration during follow-up. Bone Joint J2019; 101-B: 768–778.
5.
OrrMNKlikaAKEmaraAK, et al. Dissatisfaction after total hip arthroplasty associated with preoperative patient-reported outcome phenotypes. J Arthroplasty2022; 37: S498–S509.
6.
HalawiMJJongbloedWBaronS, et al. Patient dissatisfaction after primary total joint arthroplasty: the patient perspective. J Arthroplasty2019; 34: 1093–1096.
7.
PincusDJenkinsonRPatersonM, et al. Association between surgical approach and major surgical complications in patients undergoing total hip arthroplasty. JAMA2020; 323: 1070–1076.
8.
ManriqueJPaskeyTTarabichiM, et al. Total hip arthroplasty through the direct anterior approach using a bikini incision can be safely performed in obese patients. J Arthroplasty2019; 34: 1723–1730.
9.
LeunigMHutmacherJERicciardiBF, et al. Skin crease “bikini” incision for the direct anterior approach in total hip arthroplasty a two-to four-year comparative study in 964 patients. Bone Joint J2018; 100-B: 853–861.
10.
BertinKCRöttingerH.Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res2004; 429: 248–255.
11.
HiguchiFGotohMYamaguchiN, et al. Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision. J Orthop Sci2003; 8: 812–817.
12.
MannionAFNauerSArsoyD, et al. The association between comorbidity and the risks and early benefits of total hip arthroplasty for hip osteoarthritis. J Arthroplasty2020; 35: 2480–2487.
13.
ZhangLLixLMAyilaraO, et al. The effect of multimorbidity on changes in health-related quality of life following hip and knee arthroplasty. Bone Joint J2018; 100-B: 1168–1174.
14.
Fan ChiangYHLeeYWLamF, et al. Smoking increases the risk of postoperative wound complications: a propensity score-matched cohort study. Int Wound J2023; 20: 391–402.
15.
BurgessJLWyantWAAbujamraBA, et al. Diabetic wound-healing science. Medicina (Kaunas)2021; 57: 1072.
16.
MatsumotoTKaneujiAHiejimaY, et al. Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The subcommittee on hip disease evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci2012; 17: 25–38.
17.
ImagamaTOkazakiTMatsukiY, et al. Negative correlation between central sensitization and forgotten joint score-12 after total hip arthroplasty. J Orthop Surg Res2023; 18: 691.
18.
NeblettRCohenHChoiY, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain2013; 14: 438–445.
19.
Van De KarALCorionLUMSmeuldersMJC, et al. Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg2005; 116: 514–522.
20.
BehrendHGiesingerKGiesingerJM, et al. The “forgotten joint” as the ultimate goal in joint arthroplasty. Validation of a new patient-reported outcome measure. J Arthroplasty2012; 27: 430–436.e1.
21.
SamyDAWolfstadtJIVaideeI, et al. A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplasty2018; 33: 1379–1383.
22.
KlässboMLarssonEMannevikE.Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol2003; 32: 46–51.
23.
DawsonJFitzpatrickRCarrA, et al. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br1996; 78: 185–190.
24.
GritsDEmaraAKOrrMN, et al. Preoperative veteran RAND-12 Mental Composite Score of >60 associated with increased likelihood of patient satisfaction after total hip arthroplasty. J Arthroplasty2023; 38(Suppl. 2): S258–S264.
25.
CorrêaNFDe BritoMJADe Carvalho ResendeMM, et al. Impact of surgical wound dehiscence on health-related quality of life and mental health. J Wound Care2016; 25: 561–570.
26.
IorioRHealyWLWarrenPD, et al. Lateral trochanteric pain following primary total hip arthroplasty. J Arthroplasty2006; 21: 233–236.
27.
OgawaR.The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg2020; 149: 79e–94e.
28.
OgawaR.Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci2017; 18: 606.
