A systematic review of empirical studies between 1966 and 2005 of patient outcomes of total hip arthroplasty and related factors

Aim. To determine patient outcomes of total hip arthroplasty and the research methods used to produce knowledge of use to clinical nursing and for purposes of health education. The review consists of three parts. Firstly, it describes the patient outcomes of total hip arthroplasty. Secondly, it addresses the factors related to the patient outcomes and thirdly the research methods used are explored. Background. Previous research has identified that total hip arthroplasty is a very common procedure to reduce pain and improve physical function in patients with osteoarthritis. The greatest improvements have been found in reduction in pain. Methods. Two databases, Medline and CINAHL were searched from 1966-2005. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) empirical research and (3) the indication for total hip arthroplasty was osteoarthritis; 17 studies met the criteria. Results. Total hip arthroplasty resulted in pain relief, improved physical function and enhanced health-related quality of life regardless of patients' characteristics, type of operation or type of prosthesis. The only factor affecting patient outcomes was patients' poor pre-operative function. These patients were more likely to have postoperative pain and low postoperative physical function. Long-waiting time for surgery may reduce quality-adjusted life years. Different kinds of questionnaires were used in the studies reviewed leaving out patients' perceptions concerning the outcomes of total hip arthroplasty. Conclusions. Patients' perceptions should be assessed more closely in further research to gain subjective knowledge about the outcomes of total hip arthroplasty. This could be achieved by using qualitative methods also. Relevance to clinical practice. The findings can be seen as a challenge for nurses to plan patients' education. It is also important that the outcomes of total hip arthroplasty correspond to patients' expectations. Patients' preoperative function should be taken into consideration when planning the timing of surgery so that the best possible outcomes were attainable.