It is easy to take something as simple as walking for granted. But each year, approximately 35,000 Canadians require a hip replacement to keep them mobile.
The most common reason for needing total hip replacement (THR), the surgery where a damaged and painful hip is replaced with a new artificial joint, is advanced osteoarthritis. This condition causes joint degeneration, leading to stiffness and pain. Not only can THR alleviate pain, but it can also improve patients’ hip function, mobility and quality of life—or so it was thought. Recent studies have begun to question this belief, and are beginning to show that THR may only slightly improve the ability of patients to engage in fulfilling life activities, such as exercising, volunteering or socializing with friends and family.
To understand why this is the case, Krembil Senior Scientist Dr. Aileen Davis and TRI postdoctoral fellow Dr. Crystal MacKay had 376 patients complete a battery of questionnaires before and one year after THR. As part of the questionnaires, patients were asked to indicate how often they participate in 16 life tasks on a scale of one (never) to five (very often). The results were used to calculate what is known as the Late Life Disability Index, which describes the degree to which individuals participate in life activities.
The researchers found that those who experienced more positive life events—such as enhanced social activities, or improved work and financial situations—in the year following surgery were also more likely to engage in life activities (e.g., complete errands, exercise, visit family and friends, and volunteer).
This suggests that positive life events are a better promoter of activity than improvements in hip pain or function. Unexpectedly, complications from surgery and other health-related issues had little impact on whether individuals participated in life activities after surgery.
“Our findings indicate that to improve engagement in life activities after total hip replacement, we need to embrace a more holistic approach to treatment, which supports the person within the context of their life circumstances and not just physical rehabilitation,” says Dr. MacKay.
This work was supported by the Canadian Institutes of Health Research, the Toronto Rehab Foundation and Toronto General & Western Hospital Foundation.
MacKay C, Webster F, Venkataramanan V, Bytautas J, Perruccio AV, Wong R, Carlesso L, Davis AM. A prospective cohort study examining medical and social factors associated with engagement in life activities following total hip replacement. Osteoarthritis Cartilage. 2017 Feb 11. doi: 10.1016/j.joca.2017.02.787.