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Effect of delays on health related quality of life outcome after primary total hip arthroplasty Xu, Min

Abstract

Objective The main purpose of this research is to investigate the relationship between the waiting time for elective total hip arthroplasty (THA) and changes in the health-related quality of life (HRQOL) outcomes measured at the time of registration on the wait list and one year after the operation. The primary research objective is to assess whether expedited access to THA results in a larger proportion of patients showing "better than expected" lower-extremity function 12 months after the operation. Methods This prospective cohort study was conducted at the Vancouver Hospital & Health Sciences Center. Patients who entered the waiting list for primary THA with osteoarthritis were included in the study. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess each patient at the surgical consultation time (baseline) and one year after the operation (follow up). Log-linear regression models were used to determine whether an individual patient achieved a "better than expected" outcome. Multivariate regression models were used to assess the relationship between waiting time and the probability of achieving a "better than expected" outcome. Results We studied 147 patients at the baseline and at the follow-up assessments. The average waiting time was 6.3 months with a standard deviation of 4.4 months. We found that the baseline WOMAC score is a very significant predictor for the follow up WOMAC score in function (p=0.0005), pain (p=0.0036), and stiffness (p=0.0004). Using an individualized expected outcome based on baseline score, we determined whether a patient experienced the expected achievement through surgery. We found that waiting time was significantly associated with the probability of achieving a "better than expected" function outcome (p=0.05). Conclusions Expedited access to THA results in a larger proportion of patients showing "better than expected" lower-extremity function at 12 months after the operation. Shorter waiting time is associated with the increased probability of achieving a "better than expected" outcome for an individual patient.

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