Association between symptom duration and patient-reported outcomes before and after hip replacement surgery

Background: Patients experience discomfort and compromised quality of life whilst waiting for hip replacement. Symptom duration may affect quality of life attained following surgery, but no population-level evidence exists on the impact of symptom duration on pre- and post-surgical outcomes. Methods: National observational data collected before and after hip replacement surgery in England between 2009 and 2016 was used to investigate determinants of symptom duration prior to surgery, and the relationship between symptom duration and pre- and post-surgical patient-reported outcomes. Multivariable linear regression models were used to estimate associations between patient-reported outcomes and symptom duration, controlling for a range covariates. Results: The sample included 209,192 patients; most (69%) experienced symptoms for 1-5 years. Few patients (14%) experienced symptoms for less than a year, for longer than 5 years (6-10 years (11%), or for more than 10 years (5%). Symptom duration decreased overall over the studied time period, and was shorter among males, older and less deprived patients. Patients with a symptom duration less than one year had better post-surgical pain and function (Oxford Hip Score: 0.875, 95% CI 0.777 to 0.973) than those with 1-5 years symptom duration in an adjusted model. Conversely, those with symptom duration exceeding five years had increasingly poorer post-surgical outcomes (Oxford Hip Score: 6-10 years -0.730, 95% CI -0.847 to -0.613; >10 years -1.112, 95% CI -1.278 to -0.946). Conclusion: Symptom duration prior to hip replacement has become more standardised in England over time but increasing duration remains a significant predictor of poorer outcome after surgery.