The questionnaire response rate was 58% (2,687/4,628) for the 2-year cohort and 48% (1,627/3,421) for the 5-year cohort. Compared to nonresponders, responders to the questionnaire 2-years postrevision THA were more likely to be older (age 61–70, 71–80 with odds ratios (OR), 1.2 and 1.3, respectively, compared to ≤60 years) and less likely to have BMI 35–39.9 (OR, 0.8), higher Deyo–Charlson index (OR, 0.8 for five-point change) and have an underlying diagnosis of dislocation/fracture (OR, 0.7) or failed arthroplasty with components removed/infection (OR 0.7). At 5 years, responders were less likely to have BMI 35–39.9 (OR, 0.7), ASA class III–IV (OR, 0.8) and have an underlying diagnoses of dislocation/fracture (OR, 0.7) or failed arthroplasty with components removed/infection (OR, 0.8). Nonresponders did not differ from responders with regards to gender or distance from the medical center.
Demographic and clinical characteristics of 2- and 5-year cohorts are described in . The mean age was 65 years, 54% were women, 29% had normal BMI and 73–75% had osteolysis, wear or osteolysis as the underlying diagnosis. Among those patients who had their primary total hip arthroplasty done at the Mayo Clinic, the mean (SD) duration from primary THA to revision THA was 12.1 (7.7) years (n=1,723). Details for 2- and 5-year cohorts are shown in .
Characteristics of patients with revision THA
Moderate–severe hip pain and use of narcotics and NSAIDs for hip pain
Of the revision THAs respondents, 17.6% (451/2,553) and 19.6% (305/1,551) reported moderate–severe pain 2 and 5 years after revision THA, respectively. After multivariable adjustment, the following groups had significantly higher odds of reporting moderate–severe pain 2 years after revision THA: women had 1.3 times odds compared to men; those with BMI 30–34.9 kg/m2, 1.4 times odds compared to those with BMI ≤25; and those with depression 1.6 times odds compared to those without depression (). Patients aged 61–70 had an OR of 0.7 of reporting moderate–severe pain compared to those ≤60. Only female gender (OR, 1.5) and age 61–70 (OR, 0.7) were significant predictors of moderate–severe pain at 5-year follow-up.
Multivariable-adjusteda predictors of moderate–severe pain
Of the respondents, 17.3% (417/2,408) and 20.1% (302/1,509) were using NSAIDs at 2-year and 5-year follow-up for pain in their revised THA, respectively. NSAID use 2-years after revision THA was significantly more common in women (OR, 1.4) and in those with BMI of 30–34.9 (OR, 1.4; relative to ≤25) and less common in older subjects aged 71–80 (OR, 0.7; versus ≤60 years; ). Only women were significantly more likely to report using NSAIDs at 5 year follow-up (OR, 1.6).
Multivariable-adjusteda predictors of use of NSAIDs
Of the respondents, 6.6% (160/2,408) and 7.1% (107/1,509 were using narcotic medications at 2-year and 5-year follow-up, for pain in their revised THA, respectively. Narcotic use was significantly less common at 2-year follow-up in older subjects aged 61–70 (OR, 0.5) and 71–80 (OR, 0.4; versus ≤60) and more common in those with depression (OR, 2.4; ). At 5-year follow-up, female gender (OR, 1.8) and age 61–70 years (OR, 0.4) were significantly associated with narcotic medication use.
Multivariable-adjusteda predictors of use of narcotic medications
Comorbidity and anxiety were not associated with moderate–severe pain, NSAID or narcotic medication use 2- or 5-years after revision THA.
Moderate–severe activity limitation and dependence on walking aids
Moderate–severe activity limitation was reported by 54.9% (1,404/2,559) of respondents at 2-years and 56.1% (871/1,552) at 5 years. We found significantly higher odds of moderate–severe activity limitation at 2-year follow-up in the following groups: women (OR, 1.6); patients aged 61–70 (OR, 1.4), 71–80 (OR, 1.9) and ≥80 (OR, 3.5); higher BMI of 30–34.9 (OR, 1.9), 35–39.9 (OR, 2.1), and ≥40 (OR, 2.7); and in those with depression (OR, 1.7; ). At 5-year follow-up, an additional predictor was higher comorbidity (OR, 1.7 for five-point increase in Deyo-Charlson) and depression was no longer significantly associated with moderate–severe activity limitation ().
Multivariable-adjusteda predictors of moderate–severe activity limitation after revision THA
At 2-year follow-up, 14% (329/2,343) had some dependence and 14.5% (339/2,343) complete dependence on walking aids. At 5-year follow-up, 13.9% (204/1,466) reported some dependence, and 17.2% (252/1,466) complete dependence. Female gender was associated with significantly higher dependence on walking aids at 2- and 5-years (). Age, 71–80 and ≥80, higher BMI were associated with significantly higher odds of dependence on walking aids at 2- and 5-year follow-up ().
Multivariable-adjusteda predictors of dependence on walking/gait aids
Anxiety was not associated with moderate–severe functional limitation or use of walking aids 2- or 5-years after revision THA.
Additional covariates significantly associated with these outcomes included the following: (1) greater distance from medical center was associated with higher odds of moderate–severe pain at 5 years, use of NSAIDs at 2 years, use of narcotic medications at 2 years, moderate–severe activity limitation at 2 years, and dependence on gait aids at 2 years; (2) an underlying diagnosis of dislocation, fracture, instability or nonunion was associated with higher odds of narcotic use at 5 years, moderate–severe activity limitation at both 2- and 5-years and dependence on gait aids at 2- and 5-years; and (3) higher ASA class was associated with higher odds of moderate–severe activity limitation at both 2- and 5-years and dependence on gait aids at both 2- and 5-years.