Increased interest in studies concerning quality of life results from the necessity of improving the efficacy of health care and objectivizing treatment results. The complex nature of problems encompassing the wide range of physical and mental health, as well as the environment in which patients function, indicates the legitimacy and valuability of applying various methods and tools for measuring health condition, useful in planning and providing complex care given by various professionals, in preparing patients for self-care [2, 13]. Interest in quality of life in contemporary medicine is also a form of response to challenges and demands it faces, which result from increasing occurrence of chronic and progressing diseases in societies. It is also related to increasing life expectancy, thus the period in which patients’s functioning is substantially disturbed is extended, which influences the patient’s life situation and its subjective reception [5, 14].
Using a specific questionnaire in assessing quality of life depends on the aim of research the author wants to carry out, as it has to be suitable for the clinical situation under consideration [11]. As demonstrated in the study of Jin X et al., who compared the validity of using questionnaires EQ-5D-5L and EQ-5D-3L serving the purpose of assessing the quality of life, the EQ-5D-5L questionnaire proved to be a more sensitive research tool in case of patients after total hip reconstruction (THR), as well as total knee reconstruction (TKR). Thus, the use of EQ-5D-5L questionnaire in the above study seems fully justified [15].
The measurements of quality of life during clinical examination allowed to confirm beneficial results of treatment. As demonstrated in research, the quality of life assessed acc. to WHOQol-BREF questionnaire, concerning overall quality of life, self-assssment, and health condition, improved in the study group of patients as early as 6 weeks after surgery (p < 0.001). That result was also beneficial as showed by the subsequent checking, carried out 6 months after hip arthroplasty (p < 0.001).
Snell DL et al. evaluated the quality of life in patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA), using also the WHOQoL-BREF questionnaire, 6, 12, 24, and 60 months after the intervention. The results of their study demonstrated a positive correlation between the clinical condition and the assessed psychological aspects which influence the quality of life of treated patients [16].
Also Lapaj L. et al. evaluated the quality of life of 62 patients (44 female and 18 male ones) before and after hip arthroplasty procedure (mean follow-up: 12–18 months) using modified WHOQoL-100 questionnaire. The results of their studies confirmed significant beneficial influence of the surgical intervention upon the physical and psychological level of independence, as well as overall qualify of life in patients who were subjects of surgical treatment, whereas no influence of the surgical procedure upon the level of social independence was demonstrated [17].
It is worthwhile to refer here to the results of the study by Peeters CM et al. who made a metaanalysis of 49 studies from available databases, which refer to the assessment of health status (HR) and health-related quality of life (HRQoL) in patients over 65 years of age, after arthoplasty or capoplasty due to femur fracture. The analysis comprised the period of 6 months after surgical intervention, that is the mean follow-up. The research demonstrated that quality of life was significantly higher in the patients who underwent arthroplasty, in comparison with patients on whom capoplasty was performed [18].
In the study reported here, the authors also used most widely generic EQ-5D-5L questionnaire for evaluation of qualify of life, which also revealed a significant improvement in quality of life as early as 6 weeks after the surgery (p < 0.001), while the degree of improvement achieved (41–48%) was significantly higher 6 months after hip arthroplasty. The most remarkable improvement was noted in the reduction of pain, as well as enhanced mobility (p < 0.001).
Similar results were achieved by Costa ML. et al., who compared the clinical condition assessment using Oxford Hip Score (OHS), and quality of life using the EuroQol – EQ-5D-5L in patients after total hip arthroplasty, in comparison with resurfacing arthroplasty, in the group of 122 patients over 18 years of age, follow-up 5 years [19].
Miao N.F. et al. made the assessment of clinical condition (Oxford Hip Score and Oxford Knee Score) as well as quality of life (EQ-5D-5L) in patients who had undergone total hip arthroplasty and knee arthroplasty. The assement was made before surgical intervention, 6 weeks after it, as well as 3 and 6 months after. The authors demonstrated that functional condition and quality of life improved, while the results obtained were significantly higher in the female group after knee arthroplasty (p < 0.05) [20].
In another study, Roidis N.T. et al. assessed the quality of life using EQ-5D-5L questionnaire in 82 women after total hip arthroplasty in long follow-up (1, 2, and 12 years after surgical intervention). The results of that study demonstrated statistically significant improvement in joint mobility, as well as reduction of pain experienced, in all the three periods of observation assessed [21].
Another questionnaire used in the study reported here is SF-36 questionnaire. It assessed the physical and mental condition of the study subjects. Also in this case, quality of life improved, with statistical significance, both 6 weeks after surgery (by 21%) (p < 0.001), and 6 months after hip arthroplasty (by 54%) (p < 0.001).
SF-36 questionnaire was also used by Bahardoust M. et al., who assessed the quality of life (HRQoL), clinical condition, and socio-demographic aspects in 217 Iranian patients after total hip replacement. The mean follow-up was 18–27 weeks after the surgical intervention. The results demonstrated that hip replacement procedure influenced the improvement in the quality of life assessed, which directly influenced the clinical condition of patients, while the improvement achieved was not a constant value, and changed over the time range assessed [22].
Neuprez A. et al., in turn, assessed the influence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) upon the pain experienced and quality of life in late follow-up (5 years after the intervention) in the group of 626 surgical patients. Validated specific Western Ontario and McMaster Universities Arthritis Index (WOMAC) and generic (SF-36 and EQ-5d-5L) instruments assessing quality of life were used prior to surgery and yearly, thereafter. The beneficial effect on quality of life observed during the first year after hip and knee arthroplasty (THA and TKA) was maintained for up to 5 years. More than 3/4 of the patients in this study experienced a good outcome (86.04% in THA group and 79.91% in TKA group) [23].
Hofstede S.N. et al. conducted a study concerning the assessment of pre-surgery determinants upon the perception of quality of life, functioning, and pain experienced, in patients from 20 cohorts with OA (n = 1783) TKA and n = 2400 (THA) in the Netherlands. The authors examined the influence of age, gender, BMI, and preoperative values of HRQoL, functioning, and pain on postoperative status and total improvement. For each increase in preoperative point in HRQoL, the postoperative HRQoL increased by 0.51 points in TKA and by 0.37 points in THA in SF-36 scale. Patients with a better preoperative health status have better outcomes, but less improvement. Even though the independent effects may seem small, combined results of preoperative variables may result in larger effects on postoperative outcomes [24].
Balik M.S. et al., have also assessed, like the authors of the a/m study, the quality of life in the group of 150 patients after primary hip arthroplasty. The authors additionally assessed the psychiatric symptoms before and after the operation, in order to demonstrate disease-related socio-demographical characteristics of the patient. The Quality of Life Scale Short Form (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Harris Hip Score (HHS) and Visual Analog Scale (VAS) were implemented in the preoperative period and at 6th and 12th week after the operation. After total hip arthroplasty, significant improvement was observed in quality of life (SF-36), depression, and pain scores (VAS) [25].
It is generally believed that diseases disturb the functioning of men to various degrees, affecting man’s quality of life in its many dimensions. That is why in the process of treatment, besides achieving medical targets, an important role belongs to improving the comfort of living for the treated patient. Total hip arthroplasty is the method of choice in the treatment of advanced stages of degenerative changes in hip joint. The aim of the surgical procedure is to increase hip mobility, to enable the patient to return to professional and social activity. The above-mentioned factors have significant influence upon the improvement of patient’s quality of life.