Factors that may influence the functional outcome after primary total hip arthroplasty

AIM: The present paper aims to decipher the multiple factors occurring in patients on the recovery program, in order to obtain an optimal functional outcome after the implantation of a primary total hip prosthesis. MATERIAL AND METHOD: One hundred patients operated with primary total hip prosthesis, consecutively included in this study, underwent an immediate postoperative recovery program, with an integrative aspect, over the entire duration of hospitalization. The program was individualized according to the specific features of the patients, such as gender, age, Body Mass Index (BMI), type of diagnosis that required the prosthesis implantation, type of prosthesis implanted and functional status of the opposite hip, and it was continued at home. At 3 months postoperatively, the Harris hip score (in comparison with the preoperative one) and the quality of life were calculated. RESULTS: At 3 months post-surgery and post-recovery, the average Harris hip score was more than double in comparison with the preoperative one (85.89 as compared to 40.06), and on average the patients considered the quality of life as good. The preoperative Harris hip score had no statistically significant differences in different patient groups, except for the ones aged over 75, for whom it was statistically significantly lower than the score of other age groups. Three months after surgery, the statistically significant differences between different groups of patients disappeared. At 3 months postoperatively, the average perceived quality of life was good. There were statistically significant differences only in obese patients, who considered it to be very good. DISCUSSION: Correlations are sought between different categories of patients and the obtained results, to be compared with the data in specialized literature. CONCLUSIONS: The factors contributing to a good functional outcome after primary total hip arthroplasty are the following: rehabilitation program beginning immediately after surgery, its performance gradually reaching exercises against resistance and its integrative aspect being mainly oriented towards obtaining movement independence and walking recovery, careful adaptation to the specific features of the patient, related to age, weight condition, opposite hip condition and, within each group, related to the physical possibilities of the person submitted to surgery, as well as the continuation of the rehabilitation program at home. Factors such as gender, old age, the cause requiring prosthesis implantation, obesity or unoperated hip with functional impairment are not limitative and do not prevent obtaining satisfactory results.