title: Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty.
abstract: BACKGROUND
  In non-Western countries including Japan, activities requiring deep flexion of the hip joint, such as seiza (kneeling with calves tucked under the thighs and buttocks resting on the heels) and using squat toilets are commonly practiced. The purpose of this study was to assess longitudinal changes in traditional health-related quality of life measures and measures of physical functions associated with lifestyle for Japanese patients pre-surgery and after total hip arthroplasty.
  
  
  METHODS
  Consecutive primary total hip arthroplasty patients between July 2003 and November 2006 were eligible. Patients were measured preoperatively and at 6 weeks, 1 year and 3 years postoperatively. Patients completed the EuroQol 5D, the Western Ontario and McMaster Universities Osteoarthritis Index and items related to Japanese lifestyle activities such as squatting. Changes in these scale scores across the four time points were tested, and we examined predictive factors of EuroQol 5D score at 3-year follow-up using multiple linear regression.
  
  
  RESULTS
  Of 1103 eligible patients, 576 completed questionnaires at all four time points. By 6 weeks post-surgery, reductions in pain and improvements in physical function and stiffness became highly significant, and improvements continued to 3 years postoperative. In contrast, improvements were far more limited for items related to Japanese lifestyle functions such as seiza and use of a Japanese squat toilet, even 3 years after surgery. Predictive factors of EQ5D at 3-year post THA were WOMAC pain and physical function, seiza, age and comorbidity measured at 3-year post THA.
  
  
  CONCLUSIONS
  The rate of improvement in QOL requiring deep flexion of the hip joint was much slower than that in QOL related to Western lifestyle. Our study suggests a need for lifestyle modification for THA patients in the other countries where kneeling and squatting are commonly performed.
authors.affiliation: Department of Health Sciences, Graduate School of Medicine, Kyushu University, Japan. Electronic address: fujitak@hs.med.kyushu-u.ac.jp.
authors.forename: Kimie
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Health Sciences, Graduate School of Medicine, Osaka University, Japan. Electronic address: kmakimot@sahs.med.osaka-u.ac.jp.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Makimoto
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Japan. Electronic address: mawatam@cc.saga-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mawatari
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors