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Osteoarthritis Cartilage. 2014 Mar;22(3):389-406. doi: 10.1016/j.joca.2013.12.006. Epub 2014 Jan 1.

Total hip replacement: a systematic review and meta-analysis on mid-term quality of life.

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Melbourne Medical School, The University of Melbourne, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
Department of Orthopaedic Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia.
Department of Orthopaedic Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia. Electronic address:



Total hip replacement (THR) is one of the most successful and frequently performed operations worldwide. Health-related quality of life (HRQOL) is a key outcome measure of surgery. We investigated mid-term HRQOL after THR in patients with osteoarthritis (OA).


A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis using standardised response means. Tau(2) and I(2) values and Funnel plots were analysed.


20 studies were included. Mid-term post-operative HRQOL is superior compared to pre-operative status on qualitative and quantitative analysis. Pooled response means of total Harris Hip Score (HHS) (P < 0.00001) and combined pain (P = 0.00001) and physical function (P < 0.00001) domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and HHS improved markedly up to 7 years. Medical Outcomes Survey Short Form 36 shows physical functioning (PF) (P < 0.00001), bodily pain (BP) (P < 0.00001), role physical (P = 0.001), role emotional (P = 0.04), and social functioning (SF) (P = 0.03) were improved up to 7 years. General health (GH) (P = 0.29), mental health (MH) (P = 0.43), and vitality (P = 0.17) was similar. HRQOL is at least as good as reference populations in the first few years and subsequently plateaus or declines. Patient satisfaction and functional status was favourable. There was significant heterogeneity amongst all studies, but publication bias was low in pooled analysis.


THR confers significant mid-term HRQOL benefits across a broad range of health domains. Further studies based on consistent guidelines provided in this review are required.


Mid-term; Orthopaedic surgery; Osteoarthritis; Quality of life; Total hip arthroplasty; Total hip replacement

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