Short-stem THA Could Improve Sleep

Patients who undergo short-stem total hip arthroplasty (THA) may experience improved sleep quality, according to recent research.

“Patients with hip osteoarthrosis often describe a reduced social function as well as worse sleep quality and an increase in sleep medication use,” the researchers reported in International Orthopaedics. “A reduced sleep quality correlates with increased night pain and severity of osteoarthrosis.” Most hip osteoarthrosis patients undergo total hip replacement (THR). A short-stem hip prosthesis is a viable option for younger patients because it “promises reduced surgical trauma as well as faster post-operative recovery compared with standard-stem prosthesis,” the authors explained.

While the literature points to significantly improved quality of life—including sleep—after THR, little data exist on short-stem THA. Therefore, the researchers sought to evaluate sleep quality and daytime sleepiness in short-stem THA patients.

This prospective study included 25 patients (mean age, 68 years; 76% were female) who underwent primary unilateral hip arthroplasty for primary osteoarthritis on the affected hip between January 2016 and August 2016. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate sleep quality and daytime sleepiness; the Short Form 36 Health Survey (SF-36) and visual analog scale (VAS) were used to assess general physical health status and pain, respectively. Patients were followed for six months.

Sleep, Pain Outcomes Improve

Prior to surgery, the average PSQI score was 9.1. During the first postoperative week, the score increased slightly, then decreased—for the most part—over the next several months. By month six, the mean score was 4.3—representing normal sleep, the authors said. The mean preoperative ESS was 7.4 and dropped down to 4.2.

Nine SF-36 subcategories were considered, of which seven showed significant improvement: Physical Functioning, Role Physical, Pain, Change in Health, Energy/vitality, Role Emotional, and Mental Health; only Social Function and Health Perceptions did not largely change, which the authors noted could have been due to missing figures.

“VAS score decreased continuously from baseline 5.5 ± 1.5 over all the points and checkups during the six months post-operative follow-up until 0.1 ± 0.3 (z = − 4.43, p = 0.00, r = 0.89),” the authors further reported. They observed no significant relationship between the VAS and PSQI and the VAS and ESS.

The researchers called for a randomized controlled trial to compare sleep outcomes between standard- and short-stem hip arthroplasty patients.

Still, they concluded that short-stem hip arthroplasty patients “can expect substantial improvement regarding sleep quality, daytime sleepiness, quality of life, and pain. This information can help to shape patients’ expectations pre-operatively and reducing direct post-operative frustration due to potential sleep improvement even three months after surgery.”