title: Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry.
abstract: OBJECTIVE
  To characterize patient-level clinically meaningful improvements in pain and limitation of key activities of daily living (ADLs) after primary or revision total hip arthroplasty (THA).
  
  
  METHODS
  We analysed prospectively collected data from the Mayo Clinic Total Joint Registry to study clinically meaningful improvements in index hip pain severity and limitation in seven key ADLs (walking, climbing stairs, putting on shoes/socks, picking up objects, getting in/out of car, rising from a chair and sitting), from preoperative to 2- and 5-year post-THA.
  
  
  RESULTS
  The primary THA cohort consisted of 6168 responders preoperatively, 5707 at 2 years and 3289 at 5 years postoperatively. The revision THA cohort consisted of 2063 responders preoperatively, 2682 at 2 years and 1627 at 5 years postoperatively. In the primary THA cohort, clinically meaningful pain reduction to mild or no hip pain at 2 years was reported by 94% with moderate and 91% with severe preoperative pain; respective proportions were 91% and 89% at 5-year follow-up. For revision THA, respective proportions were 84% and 77% at 2 years and 80% and 78% at 5 years. In the primary THA cohort, up to 4% with moderate and 17% with severe preoperative ADL limitation reported severe limitation in the respective activity 2 years post-primary THA; at 5 years, the respective proportions were up to 7% and 20%. Respective proportions for revision THA were up to 10% and 26% at 2 years and 13% and 30% at 5 years.
  
  
  CONCLUSIONS
  These comprehensive data for patient-level clinically meaningful improvements in pain and seven key ADLs can help patients set realistic goals for improvement after THA.
authors: Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. jasvinder.md@gmail.com
authors: Jasvinder A
authors: JA
authors: Singh
authors: David G
authors: DG
authors: Lewallen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000534:rehabilitation / Q000601:surgery*; D010146:Pain / Q000534:rehabilitation / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D020127:Recovery of Function; D012042:Registries; D012086:Reoperation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
keywords: activities of daily living; activity limitation; arthroplasty; function; functional limitation; joint replacement; outcomes; pain; patient-reported outcomes; primary; revision; total hip replacement
references: BMJ Open. 2012 Feb 22;2(1):e000435
references: 22357571
references: J Bone Joint Surg Am. 1991 Mar;73(3):397-409
references: 2002078
references: J Clin Epidemiol. 1997 Mar;50(3):239-46
references: 9120522
references: Lancet. 2007 Oct 27;370(9597):1508-19
references: 17964352
references: Clin Orthop Relat Res. 2003 Dec;(417):62-73
references: 14646703
references: J Arthroplasty. 1996 Aug;11(5):565-71
references: 8872577
references: BMC Musculoskelet Disord. 2010 May 13;11:90
references: 20462458
references: Semin Arthritis Rheum. 2012 Feb;41(4):576-88
references: 22035624
references: J Arthroplasty. 1997 Jun;12(4):387-96
references: 9195314
references: Med J Aust. 2010 Jul 5;193(1):17-21
references: 20618108
references: Clin Rheumatol. 2009 Dec;28(12):1419-30
references: 19727914
references: J Bone Joint Surg Am. 2004 May;86(5):963-74
references: 15118039
references: J Arthroplasty. 1996 Jan;11(1):47-57
references: 8676118
references: J Bone Joint Surg Am. 2006 Apr;88(4):685-91
references: 16595456
references: J Clin Epidemiol. 1992 Jun;45(6):613-9
references: 1607900
references: J Bone Joint Surg Br. 1972 Nov;54(4):621-5
references: 4639438
references: J Am Geriatr Soc. 2010 Dec;58(12):2387-93
references: 21143444
references: J Rheumatol. 2002 Jun;29(6):1273-9
references: 12064846
references: J Bone Joint Surg Am. 2003 Feb;85(2):259-65
references: 12571303
references: J Bone Joint Surg Am. 2007 Apr;89(4):780-5
references: 17403800
references: Acta Anaesthesiol Scand. 2006 Apr;50(4):495-500
references: 16548863
references: J Rheumatol. 2007 Feb;34(2):394-400
references: 17143967
references: Clin Orthop Relat Res. 1985 Mar;(193):133-40
references: 3971612
references: Value Health. 2010 Jun-Jul;13(4):447-54
references: 20088892
references: Arch Intern Med. 2001 Feb 12;161(3):454-60
references: 11176772
references: Ann Rheum Dis. 2003 Oct;62(10):935-8
references: 12972470
references: J Bone Joint Surg Am. 1969 Jun;51(4):737-55
references: 5783851