Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

Abstract

Background: Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence. Methods: We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared. Results: We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 ( p  = 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p  < 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively ( p  = 0.154 and 0.012, respectively), and both sides did at days 5 ( p  = 0.019 and <0.001, respectively), 7, 10, and 14 (both p  < 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p  = 0.021) and 5 (0.67 vs. 0.71; p  = 0.040), with no significant difference after day 7. Conclusions: Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.