A nomogram model to predict the risk of early hip dysfunction after total hip arthroplasty in older adults

DING Yun-xia; ZHONG Li; QIAN Meng-lin; DU Xiao-hua; GUANG Bo; XING Cheng-tao

doi:10.3969/j.issn.2095-252X.2024.07.010

Abstract：Objective To analyze the factors that affect hip dysfunction in the early postoperative period after total hip arthroplasty in the elderly and construct a nomogram model.Methods Two hundred and thirty-six elderly hip fracture patients treated with total hip arthroplasty(THA)between January 2018 and May 2021 in our hospital were selected.They were randomly divided into training group(n=118)and validation group(n=118)in a 1:1 ratio.Postoperative hip functional status was assessed in elderly hip fracture patients using the modified Iowa level of assistance scale(mILAS).A multivariate Logistic regression model was used to analyse the risk factors for early postoperative hip dysfunction of patients in the training group and to construct a nomogram model.In the training and validation groups,the predictive accuracy of the nomogram model was assessed by calibration curves.Results The operation time and intraoperative bleeding of patients in the training group were lower than that of patients in the validation group(P<0.05);haemoglobin(Hb)and albumin(ALB)were higher than that of patients in the validation group(P<0.05).In the training group,36 patients(30.5%)had early hip dysfunction.Age,body mass index(BMI),smoking,mini-mental state examination(MMSE)score,American Society of Anesthesiologists(ASA)grade,mini nutritional assessment short form(MNA-SF)score,timing of surgery,Hb,ALB,and C-reactive protein(CRP)were statistically different in patients with postoperative hip dysfunction compared with patients with good postoperative hip function(P<0.05).Age(≥75 years),BMI(<18.5,≥25),ASA grade(Ⅲ grade,Ⅳ grade),MNA-SF score(malnutrition),and ALB(≤35 g/L)were independent risk factors for postoperative hip dysfunction(P<0.05).The area under the curve(AUC)values of the nomogram model in the training and validation groups were 0.822(0.772-0.756)and 0.751(0.706-0.771),respectively.Conclusions Age,BMI,ASA classification,MNA-SF score and ALB are associated with the risk of early postoperative hip dysfunction in the elderly THA patients,and the developed nomogram model can effectively predict the risk.