title: Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.
abstract: OBJECTIVE
  Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty.
  
  
  METHODS
  This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis) and revision (n = 43) hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0-3 months and 3-12 months) between types of surgery.
  
  
  RESULTS
  The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty.
  
  
  CONCLUSIONS
  The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be improved with specific post-operative interventions.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
authors.forename: Erik
authors.identifier: http://orcid.org/0000-0002-0371-731X
authors.initials: E
authors.lastname: Lenguerrand
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Whitehouse
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
authors.forename: Vikki
authors.initials: V
authors.lastname: Wylde
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy; D010146:Pain / Q000473:pathology*; D011184:Postoperative Period; D011446:Prospective Studies; D011475:Prosthesis Failure; D020127:Recovery of Function; D012044:Regression Analysis; D012086:Reoperation; D057566:Self Report; D016896:Treatment Outcome; D016138:Walking