title: Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity.
abstract: OBJECTIVE
  Revision hip arthroplasty is associated with less favorable short and longterm results than primary total hip arthroplasty (THA). We compared quality of life and satisfaction 5 years after the 2 interventions, to determine the influence of patient characteristics on poorer outcomes after revision, and to analyze if their influence differed for primary and for revision arthroplasty.
  
  
  METHODS
  This was a hospital-based prospective cohort study including patients who underwent primary (n = 435) or revision THA (n = 116). Quality of life was measured by Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Medical Outcomes Study Short Form-12 questionnaire. Satisfaction was evaluated with a visual analog scale.
  
  
  RESULTS
  Patients undergoing a revision were older, more often obese, and had more medical and orthopedic comorbidities. Five years after surgery, 349 patients with primary THA and 85 with revisions were available for followup. Unadjusted quality of life and satisfaction were significantly lower after revision (Harris Hip Score 76.7 vs 88.1; WOMAC pain 66.4 vs 73.3; WOMAC function 61.6 vs 70.0; satisfaction 7.7 vs 8.9). Adjustment for patient characteristics revealed that this difference was partly explained by the greater morbidity and older age of patients undergoing revision. The influence of age, comorbidities, and preoperative function on 5-year outcomes did not substantially differ for the 2 intervention groups. However, obesity was associated with a stronger negative effect on revision surgery.
  
  
  CONCLUSIONS
  Patients and physicians should acknowledge additional risks and consequently lower results associated with revision THA. Better information and medical preparation before surgery may help to improve the success of revision surgery.
authors.affiliation: Department of Orthopaedic Surgery, Geneva University Hospital, Geneva, Switzerland. anne.lubbekewolff@hcuge.ch
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation / Q000009:adverse effects*; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome