Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases.

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A retrospective...", "datePublished": "2025-08-15T15:17:16", "dateModified": "2025-08-15T15:17:16", "author": [ { "@type": "Person", "name": "Aymen Fekih" }, { "@type": "Person", "name": "Jacem Saadana" }, { "@type": "Person", "name": "Firas Boughattas" }, { "@type": "Person", "name": "Ikram Haddada" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Total hip arthroplasty (THA) is now a well-established and reliable procedure that effectively reduces pain, restores mobility and enhances functionality. This study aim to evaluate the quality of life and functional outcomes of patients who underwent THA for hip osteoarthritis, and to identify the factors influencing these outcomes. Methods A retrospective study was conducted involving 200 patients who underwent THA for hip osteoarthritis. Functional outcomes were assessed using the Postel-Merle d’Aubigné (PMA) score. Quality of life and patient satisfaction were evaluated using the Short Form Health Survey-12 (SF-12), the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Results The PMA score increased from 7 to 14 points (p = 0.008), the SF-12 PCS rose from 29.76 to 48.71 (p < 0.001), and the SF-12 MCS increased from 49.24 to 54.49 (p < 0.001). The HOOS improved from 35/100 to 76/100 (p < 0.001). The PSQI decreased from 7/21 to 3/21 (p < 0.001). The HADS depression and anxiety fell from 6.8/21 to 3.8/21 (p < 0.001) and from 8.4/21 to 4.8/21 (p < 0.001), respectively. Physical and mental health were positively associated with walking autonomy and higher BMI. Hip function outcomes were better in patients with ceramic on-ceramic articulations, younger age, and higher postoperative PMA scores. Good sleep quality and decreased depression score were associated with increased walking distance and BMI. There were no significant associations between anxiety and any of the variables investigated. Conclusions These findings highlight the effectiveness of THA not only in restoring mobility but also in enhancing overall patient well-being. Integrating both functional and quality-of-life assessments into patient care offers a comprehensive approach to postoperative management and may optimize long-term outcomes for patients with hip osteoarthritis. 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F1000Research 2025, 14 :792 ( https://doi.org/10.12688/f1000research.168896.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] Aymen Fekih https://orcid.org/0000-0003-4681-6075 1 , Jacem Saadana 1 , Firas Boughattas https://orcid.org/0009-0002-4434-9557 1 , Ikram Haddada https://orcid.org/0009-0008-4115-2680 2 Aymen Fekih https://orcid.org/0000-0003-4681-6075 1 , Jacem Saadana 1 , Firas Boughattas https://orcid.org/0009-0002-4434-9557 1 , Ikram Haddada https://orcid.org/0009-0008-4115-2680 2 PUBLISHED 15 Aug 2025 Author details Author details 1 Department of Orthopedic Surgery, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia 2 Department of Physical Medicine and Rehabilitation, Taher Sfar University Hospital, Mahdia, Tunisia Aymen Fekih Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Jacem Saadana Roles: Conceptualization, Visualization, Writing – Original Draft Preparation Firas Boughattas Roles: Conceptualization, Formal Analysis, Visualization, Writing – Original Draft Preparation Ikram Haddada Roles: Conceptualization, Methodology, Software, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Total hip arthroplasty (THA) is now a well-established and reliable procedure that effectively reduces pain, restores mobility and enhances functionality. This study aim to evaluate the quality of life and functional outcomes of patients who underwent THA for hip osteoarthritis, and to identify the factors influencing these outcomes. Methods A retrospective study was conducted involving 200 patients who underwent THA for hip osteoarthritis. Functional outcomes were assessed using the Postel-Merle d’Aubigné (PMA) score. Quality of life and patient satisfaction were evaluated using the Short Form Health Survey-12 (SF-12), the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Results The PMA score increased from 7 to 14 points (p = 0.008), the SF-12 PCS rose from 29.76 to 48.71 (p < 0.001), and the SF-12 MCS increased from 49.24 to 54.49 (p < 0.001). The HOOS improved from 35/100 to 76/100 (p < 0.001). The PSQI decreased from 7/21 to 3/21 (p < 0.001). The HADS depression and anxiety fell from 6.8/21 to 3.8/21 (p < 0.001) and from 8.4/21 to 4.8/21 (p < 0.001), respectively. Physical and mental health were positively associated with walking autonomy and higher BMI. Hip function outcomes were better in patients with ceramic on-ceramic articulations, younger age, and higher postoperative PMA scores. Good sleep quality and decreased depression score were associated with increased walking distance and BMI. There were no significant associations between anxiety and any of the variables investigated. Conclusions These findings highlight the effectiveness of THA not only in restoring mobility but also in enhancing overall patient well-being. Integrating both functional and quality-of-life assessments into patient care offers a comprehensive approach to postoperative management and may optimize long-term outcomes for patients with hip osteoarthritis. READ ALL READ LESS Keywords Osteoarthritis, Total hip arthroplasty, Functional impact, Quality of life Corresponding Author(s) Aymen Fekih ( [email protected] ) Close Corresponding author: Aymen Fekih Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Fekih A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Fekih A, Saadana J, Boughattas F and Haddada I. Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.12688/f1000research.168896.1 ) First published: 15 Aug 2025, 14 :792 ( https://doi.org/10.12688/f1000research.168896.1 ) Latest published: 15 Aug 2025, 14 :792 ( https://doi.org/10.12688/f1000research.168896.1 ) Introduction Hip osteoarthritis is the primary condition leading to total hip arthroplasty (THA), a well-known procedure that has changed its treatment forever. 1 , 2 THA aims to relieve pain, improve movement, restore function, and ultimately optimize the socio-professional life and quality of life of the affected patients. 3 Quality of life evaluation becomes the major criterion in the determination of THA’s efficacy. Such assessments are crucial for understanding patient needs, setting expectations, and evaluating treatment outcomes. Quality-of-life evaluations should encompass physical, psychological, and social domains. 4 This study aims to 1) evaluate the quality of life of patients undergoing THA for hip osteoarthritis using established, generic instruments: the Postel-Merle d’Aubigné score (PMA), the Short Form Health Survey (SF-12), the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS); and 2) analyze the factors that may influence postoperative quality of life in these patients. Materials and methods Study design Approval was obtained from the Institutional Review Board (IRB) of Fattouma Bourguiba Hospital (CEM-2018-12-15) for the conduct of this retrospective study performed on patients who underwent primary THA for hip osteoarthritis from January 2019 to December 2020 at Fattouma Bourguiba Hospital. The design and reporting were performed in accordance to the Declaration of Helsinki. The written informed consent was waived by the IRB due to the retrospective nature of the study. Patient confidentiality was maintained through anonymized data collection and analysis. The inclusion criteria for the patient’s analysis were: (1) patients undergoing THA for hip osteoarthritis, whether degenerative or secondary to a systemic disease; (2) patients capable of providing written or verbal responses to questionnaires; and (3) those with minimum follow-up duration of two years postoperatively. The following patients were excluded: (1) post-traumatic THA cases; (2) patients with active infections or acute exacerbations of chronic medical conditions; (3) patients unable to complete self-reported questionnaires due to cognitive impairment; and (4) patients with significant neuromuscular or vascular comorbidities affecting lower limb function. Data collection protocol We systematically collected data from electronic medical records using a standardized case report form that included (1) demographic and epidemiological data (age, sex, body mass index (BMI), occupational status, comorbidities, preoperative functional status), (2) clinical parameters (affected side and symptom duration, gait perimeter assessment, surgical approach, implant characteristics) and (3) postoperative evolution (immediate and late complications, rehabilitation protocol details). The scoring was based on a direct interview with the patient (190 cases) during follow-up and in rare cases (10 patients) it was based on a telephone interview with clarification of contentious issues. Functional evaluation We assessed hip function using the validated Postel-Merle d’Aubigné (PMA) score preoperatively and at the final follow-up. This 18-point scale evaluates pain (0-6 points), mobility (0-6 points), and walking ability (0-6 points). 5 Scores were categorized as Very good (≥12 points), Good (10-11 points), Average (9 points), Low (8 points) and Poor (≤7 points). Quality of life assessment We employed four validated instruments: 1) SF-12 Health Survey: assessed physical (PCS) and mental (MCS) health components and scored from 0 to 100. Higher scores indicate a better quality of life. 6 2) Hip Disability and Osteoarthritis Outcome Score: evaluated five domains: Pain (10 items), Symptoms (5 items), Activities of Daily Living (17 items), Sports and Recreation (4 items), and Hip-related quality of life (4 items). 7 Transformed to a 0-100 scale, higher scores indicate better function and less pain. 8 3) Pittsburgh Sleep Quality Index: used for assessing seven sleep components with a global score ranging from zero to 21. 9 A score greater than 5 indicates poor sleep quality. 10 4) Hospital Anxiety and Depression Scale: used for identifying and quantifying symptoms of anxiety and depression and divided into two subscales Anxiety subscale (HADS-A, 7 items) and Depression subscale (HADS-D, 7 items). Each subscale is scored from 0 to 21. 11 , 12 The following cutoff scores are commonly used to interpret the HADS subscale scores: 0-7: Normal; 8-10: Mild symptoms and 11-21: Moderate to severe symptoms. 13 Statistical analysis We performed all analyses using SPSS version 26 (IBM Corp.). Descriptive statistics included means for normally distributed continuous variables, medians for non-normal distributions, and frequencies for categorical variables. For inferential analysis, we used Student’s t-test for normally distributed continuous variables, Pearson’s chi-square or Fisher’s exact test for categorical variables, and Pearson correlation for continuous variable associations. All tests were two-tailed with a p = 0.05 significance threshold. Results Study population and baseline characteristics This study included 200 eligible patients. The cohort had a male predominance (59% male, 41% female), with a male-to-female ratio of 1.43. The mean age was 49 ± 15.59 years (range: 35–78), with most patients (62.5%) aged between 40 and 65 years. The right hip was operated on 120 patients and the left hip on 80. THA was bilateral in 30 patients ( Table 1 ). Table 1. Characteristics of the population’s study. Population characteristics Total (n=200) Sex Male 108 (59) Female 82 (41) Age (years) <40 25 (12.5) [40-65] 125 (62.5) ≥65 50 (50) Operated side Right 120 (60) Left 80 (40) BMI ((kg/m 2 ) Normal (18.5 to 24.9) 82 (41) Overweight (25 to 29.9) 78 (39) Obese (≥30) 40 (20) Occupational status Employees 102 (51) Housewives 48 (24) Retired 50 (25) Causes of hip osteoarthritis Primary 105 (52.5) Rheumatoid arthritis 65 (32.5) Ankylosing spondylitis 30 (15) Friction torque Ceramic on ceramic 120 (60) Metal on highly cross-linked polyethylene 80 (40) Femoral stem Cemented 74 (37) Uncemented 126 (63) Acetabular component Cemented 76 (38) Uncemented 124 (62) Postoperative walk autonomy Independent 165 (82.5) Single cane 27 (13.5) Two canes 8 (4) BMI distribution revealed that 20% of patients were obese, 39% overweight, and 41% had a normal BMI. Occupational status varied: 51% were employees, 24% were housewives, and 25% were retired. Metabolic syndrome was present in 30% of the cohort. The average duration of symptoms was four years, with extremes ranging from two to six years. Primary hip joint involvement was observed in 52.5% of cases, while 47.5% were secondary to systemic disease mainly rheumatoid arthritis and ankylosing spondylitis. All patients presented with a reduced gait perimeter, with a median walking distance of 200 ± 158 meters preoperatively. In all cases, the surgical approach used was the posterolateral Moore technique. Ceramic on-ceramic articulation was used in 60% of cases. Metal on highly cross-linked polyethylene was used in 40% of cases. Regarding prosthesis fixation, femoral stems were cemented in 37% of cases, while 63% were uncemented. These ratios are similar for acetabular components (38% cemented and 62% uncemented). Five cases of prosthesis dislocation occurred within two months of surgery, with no recurrence. There were also ten cases of early sepsis, which were managed through repeat surgery involving debridement and lavage, as well as appropriate antibiotic therapy. The outcome was good. No late complications were reported at the last follow-up. Postoperatively, all patients stood up on the day of the operation, and 75% began ambulating immediately the day after. Rehabilitation protocol applied to all patients included muscle strengthening, analgesic physiotherapy, and patient education to prevent dislocating movements of the prosthesis. After a mean follow-up of three years (range: two to four years), 82.5% walked independently, 13.7% used a single cane, and only 3.8% required two canes, demonstrating significant functional improvement (p = 0.017). Functional and quality of life outcomes THA led to significant functional improvements ( Table 2 ), as demonstrated by the PMA scale (p = 0.008). The mean PMA score more than doubled, increasing from 7/18 (±2) preoperatively to 14/18 (±4) postoperatively. Clinically, this translated to a dramatic decline in patients with “poor” function (53.8% preoperatively vs. postoperatively) and a substantial rise in those achieving “very good” scores (87.2%). Table 2. Functional and quality of life outcomes. Preoperatively Postoperatively PMA score Poor 53.8% 0 Low 28.2% 0 Average 14.1% 0 Good 3.8% 12.8% Very good 0 87.2% SF-12 score PCS 29.76 48.71 MCS 49.24 54.49 HOOS Symptoms 50 87.5 Pain 35 80 Activity 37.5 80.9 Sports and recreation 18.8 43.8 Quality of life 31.3 68.8 PSQI Bad sleepers 75.6% 12.8% Good sleepers 24.4% 87.2% HADS Definite depression 12.8% 9% No depression 87.2% 91% Definite anxiety 28.2% 5.1% No anxiety 71.8% 94.9% Patients also experienced marked enhancements in quality of life, measured by the SF-12 survey. The PCS improved from 29.76 to 48.71 (p < 0.001), while the MCS rose from 49.24 to 54.49 (p < 0.001), indicating better physical and psychological well-being. Hip-specific function, assessed via the HOOS, showed significant gains (p < 0.001), with the global score improving from 35 to 76. Preoperatively, the greatest limitations were in Sports/Leisure activities, while the Symptoms domain was the least severe among the HOOS subscales. Postoperatively, Activity domains improved the most, though Sports/Leisure remained challenging. Sleep quality, evaluated using the PSQI, also improved significantly, with scores dropping from 7/21 (±2.75) to 3/21 (±2.07) (p < 0.001). The proportion of “good sleepers” (PSQI ≤5) increased from 24.4% to 87.2%. Psychological assessments using the HADS revealed reduced depression from 6.8/21 ±2.86 to 3.8/21 ±2.21 (p < 0.001) and anxiety from 8.4/21 ±3.06 to 4.8/21 ±2.66) (p < 0.001). Preoperatively, 12.8% had “definite depression” and 28.2% had “definite anxiety”; postoperatively, these rates fell to 9% and 5.1%, respectively. Factors influencing postoperative quality of life after total hip arthroplasty This study identified several significant factors associated with improved quality of life following THA ( Table 3 ). Physical health outcomes (SF-12 PCS) showed positive correlations with a history of rheumatic diseases (p = 0.017), post-operative walking autonomy (p = 0.011), shorter hospital stay (p = 0.048), and earlier mobilization (p = 0.046). Mental health (SF-12 MCS) was significantly linked to walking autonomy (p = 0.011), greater walking distance (p = 0.003), and BMI (p = 0.043). Table 3. Factors influencing postoperative quality of life after total hip arthroplasty. Postoperative PCS p-value Postoperative MCS p-value Postoperative HOOS p-value Sex 0.683 0.412 0.944 Male (n=108) 48.45±6.90 54.04±6.11 75.59±9.35 Female (n=82) 49.07±6.38 55.16±5.23 75.44±8.35 Age (years) 0.053 0.053 0.002 ≤40 51.65±6.52 56.45±5.03 79.42±8.97 >40 46.79±4.67 54.63±4.73 68.28±7.56 Operated side 0.485 0.476 0.773 Unilateral (n=170) 49.20±5.67 54.05±0.88 75.80±9.16 Bilateral (n=30) 48.13±7.69 55.01±1.02 75.21±8.70 BMI 49.24±6.44 0.906 54.72±5.87 0.043 76.18±8.68 0.592 Rheumatic diseases 0.017 0.403 0.091 No (n=105) 46.56±6.58 53.66±6.03 72.58±8.28 Yes (n=95) 50.43±5.11 54.98±5.77 76.78±10.17 Friction torque 0.160 0.631 0.03 Metal on highly cross-linked polyethylene (n=80) 48.21±6.79 54.31±6.06 73.97±9.12 Ceramic on-ceramic (n=120) 50.49±6.20 54.99±5.48 78.67±8.40 Mobilization 48.82±6.81 0.046 54.62±5.82 0.874 75.79±8.79 0.027 Hospital stay 49.20±6.29 0.048 54.43±5.91 0.933 75.83±8.94 0.229 Postoperative walk autonomy 0.011 0.011 0.352 Independent (n=165) 49.59±6.44 54.68±5.55 77.79±7.88 Single or two canes (n=35) 46.83±6.12 53.59±6.75 66.45±5.72 Walking distance 48.66±6.82 0.083 54.50±5.80 0.003 75.73±8.54 0.541 Postoperative PMA 48.52±1.90 0.501 54.00±2.38 0.450 75.53±1.90 0.01 Hip function, assessed by the HOOS, improved with ceramic on ceramic articulation (p = 0.03), younger age (p = 0.002), earlier post-operative mobilization (p = 0.027), and higher post-operative PMA scores (p = 0.01). Sleep quality was positively associated with walking distance (p = 0.018), while depression scores decreased with increased walking distance (p = 0.037) and higher BMI (p = 0.043). No significant associations were found between anxiety and any of the studied variables (p > 0.05). Discussion This study, involving 200 patients with hip osteoarthritis, investigated the impact of THA on functional and quality of life outcomes. We found significant improvements across multiple domains post-THA. Functional outcomes, assessed by the PMA score, more than doubled from a mean of 7 pre-operatively to 14 post-operatively. This aligns with existing literature demonstrating a clear improvement in PMA scores, rising from 6.9 preoperatively to 15 postoperatively. 14 , 15 Quality of life was significantly enhanced, as evidenced by validated tools such as SF-12, HOOS, PSQI, and HAD scores. 16 The SF-12 PCS increased from 29.76 to 48.71, while the MCS rose from 49.24 to 54.49. These findings are consistent with previous research demonstrating a statistically significant improvement in mean PCS (31.2 ± 9.7, p = 0.001) and MCS (51.6 ± 17.6, p = 0.024) after THA. 17 Several studies have concluded that patients’ quality of life automatically improves with improved hip function, based on functional scores. 18 The HOOS, a hip-specific questionnaire, 19 showed a marked improvement from 35 pre-operatively to 76 post-operatively across all domains, including the most affected pre-operative domains: HOOS-Sports and Recreation and HOOS-Quality of Life. However, one study noted no improvement in Sports and Recreation. 20 Sleep quality significantly improved, with the overall PSQI decreasing from 7/21 to 3/21. The percentage of “good sleepers” increased from 24.4% to 87.2%. Postoperative sleep quality depends on several factors, some of which are uncontrollable, such as advanced age and preoperative comorbidities, while others are controllable, such as the invasiveness of the surgical procedure, the type of anesthesia, and postoperative pain that prevents the patient from finding a comfortable sleeping position. 21 Pre-operative pain severity and duration are known risk factors for postoperative pain and sleep issues. 22 Psychological distress also decreased significantly. The HAD score showed a reduction in total depression scores from 6.8/21 to 3.8/21, and anxiety scores from 8.4/21 to 4.8/21. This led to a decrease in “definite depression” from 12.8% to 9% and “definite anxiety” from 28.2% to 5.1%. Pre-operative screening and treatment for depression and anxiety can optimize outcomes and reduce costs. 23 While psychological disorders aren’t contraindications, their treatment can improve outcomes, as painful complaints post-THA can have a psychiatric origin. 24 , 25 Several factors positively influenced post-operative quality of life such as history of rheumatic diseases, walking autonomy, shorter hospital stays, earlier mobilization, ceramic-on-ceramic articulation, younger age, and higher BMI. These findings underscore the critical role of mobility, early rehabilitation, and appropriate implant selection in achieving optimal recovery and overall well-being after THA. This study’s limitations include its retrospective data analysis, the absence of a control group, and the lack of analysis regarding potential confounding factors. Specifically, the impact of pain management, socioeconomic status, and surgeon experience on outcomes was not assessed, which could influence the generalizability and interpretation of the findings. Conclusion Total Hip Arthroplasty significantly improves the quality of life for patients with hip osteoarthritis by restoring mobility and enhancing overall well-being. To further optimize care, future efforts should focus on personalized rehabilitation, enhanced preoperative assessments, and integrated mental health support. This will address persistent limitations and psychological symptoms, solidifying THA’s value as a holistic treatment. Ethical considerations Approval was obtained from the Institutional Review Board (IRB) of Fattouma Bourguiba Hospital (CEM-2018-12-15) for the conduct of the study. The design and reporting were performed in accordance to the Declaration of Helsinki. The written informed consent was waived by the IRB due to the retrospective nature of the study. Patient confidentiality was maintained through anonymized data collection and analysis. Data availability The datasets generated and/or analysed during the current study are not publicly available due to preserve data confidentiality and patient anonymity but are available from the corresponding author Dr Fekih Aymen (e-mail: [email protected] ) on reasonable request. The protection of personal data is governed by a law promulgated by the National Authority for Protection of Personal Data in Tunisia which stipulates that data may only be shared after informed consent and request. There is no intermediary data that can be de-identified without compromising anonymity. The same thing was explained by the Institutional Review Board of our hospital. References 1. Fautrel B, Hilliquin P, Rozenberg S, et al. : Impact of osteoarthritis: results of a nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine. 2005; 72 : 235–240. PubMed Abstract | Publisher Full Text 2. Belbachir A: Prise en charge de la douleur après prothèse totale de hanche. Douleurs Eval. - Diagn. - Trait. 2012; 13 : 63–73. Publisher Full Text 3. Kassimi EH, Abdelfettah Y, Khadir A, et al. : Résultats fonctionnels et qualité de vie après prothèse totale de hanche: à propos de 93 cas. J. Réadapt. Médicale Prat. Form. En Médecine Phys. Réadapt. 2014; 34 : 60–65. Publisher Full Text 4. Currey HL: Osteoarthrosis of the hip joint and sexual activity. Ann. Rheum. Dis. 1970; 29 : 488–493. PubMed Abstract | Publisher Full Text | Free Full Text 5. d’Aubigné RM, Postel M: The Classic: Functional Results of Hip Arthroplasty with Acrylic Prosthesis. Clin. Orthop. Relat. Res. 2009; 467 : 7–27. PubMed Abstract | Publisher Full Text | Free Full Text 6. Younsi M, Chakroun M: Measuring health-related quality of life: psychometric evaluation of the Tunisian version of the SF-12 health survey. Qual. Life Res. 2014; 23 : 2047–2054. PubMed Abstract | Publisher Full Text 7. Lyman S, Lee YY, Franklin PD, et al. : Validation of the HOOS, JR: A Short-form Hip Replacement Survey. Clin. Orthop. Relat. Res. 2016; 474 : 1472–1482. PubMed Abstract | Publisher Full Text | Free Full Text 8. Nilsdotter AK, Lohmander LS, Klässbo M, et al. : Hip disability and osteoarthritis outcome score (HOOS)-validity and responsiveness in total hip replacement. BMC Musculoskelet. Disord. 2003; 4 : 10. PubMed Abstract | Publisher Full Text | Free Full Text 9. Suleiman KH, Yates BC, Berger AM, et al. : Translating the Pittsburgh Sleep Quality Index Into Arabic. West. J. Nurs. Res. 2010; 32 : 250–268. PubMed Abstract | Publisher Full Text 10. Buysse DJ, Reynolds CF, Monk TH, et al. : The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28 : 193–213. PubMed Abstract | Publisher Full Text 11. Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatr. Scand. 1983; 67 : 361–370. Publisher Full Text 12. 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Gandek B, Ware JE, Aaronson NK, et al. : Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J. Clin. Epidemiol. 1998; 5 : 1171–1178. 17. Bahardoust M, Hajializade M, Amiri R, et al. : Evaluation of health-related quality of life after total hip arthroplasty: a case-control study in the Iranian population. BMC Musculoskelet. Disord. 2019; 20 : 46. PubMed Abstract | Publisher Full Text | Free Full Text 18. Ethgen O, Bruyère O, Richy F, et al. : Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J. Bone Joint Surg. Am. 2004; 86 : 963–974. PubMed Abstract 19. Shields RK, Enloe LJ, Leo KC: Health related quality of life in patients with total hip or knee replacement. Arch. Phys. Med. Rehabil. 1999; 80 : 572–579. Publisher Full Text 20. Judd DL, Dennis DA, Thomas AC, et al. : Muscle strength and functional recovery during the first year after THA. Clin. Orthop. Relat. Res. 2014; 472 : 654–664. PubMed Abstract | Publisher Full Text | Free Full Text 21. El Chalouhi M: Sommeil et hypersensibilité préopératoires: comparaison entre les patients prévus pour une chirurgie élective prothétique de genou et de hanche. Faculté de médecine et médecine dentaire. Université catholique de Louvain; 2020. Prom.: Lavand’homme, Patricia. Reference Source 22. Latremoliere A, Woolf CJ: Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J. Pain. 2009; 10 : 895–926. PubMed Abstract | Publisher Full Text | Free Full Text 23. Mossey JM, Knott K, Craik R: The effects of persistent depressive symptoms on hip fracture recovery. J. Gerontol. 1990; 45 : M163–M168. PubMed Abstract | Publisher Full Text 24. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 15 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Orthopedic Surgery, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia 2 Department of Physical Medicine and Rehabilitation, Taher Sfar University Hospital, Mahdia, Tunisia Aymen Fekih Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Jacem Saadana Roles: Conceptualization, Visualization, Writing – Original Draft Preparation Firas Boughattas Roles: Conceptualization, Formal Analysis, Visualization, Writing – Original Draft Preparation Ikram Haddada Roles: Conceptualization, Methodology, Software, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 15 Aug 2025, 14:792 https://doi.org/10.12688/f1000research.168896.1 Copyright © 2025 Fekih A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Fekih A, Saadana J, Boughattas F and Haddada I. Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.12688/f1000research.168896.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 15 Aug 2025 Views 0 Cite How to cite this report: Jenzri M. Reviewer Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448064 ) The direct URL for this report is: https://f1000research.com/articles/14-792/v1#referee-response-448064 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Mar 2026 Mourad Jenzri , MT Kassab Orthopaedic Institute, Tunis, Tunisia Approved VIEWS 0 https://doi.org/10.5256/f1000research.186116.r448064 Title: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. Reviewing assessment: Approved Executive Summary The study investigates the functional and ... Continue reading READ ALL Title: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. Reviewing assessment: Approved Executive Summary The study investigates the functional and psychological outcomes of THA with a minimum two-year follow-up. Using a wide battery of validated tools (PMA, HOOS, SF-12, PSQI, and HADS), the authors demonstrate significant improvements in: Physical Function: Substantial gains in mobility and hip-specific scores. Quality of Life: Enhanced general health perception. Well-being: Notable reductions in sleep disturbances, anxiety, and depression. Key Strengths Holistic Assessment: Moves beyond simple joint function to include mental health and sleep. Sample Size: 200 cases provide strong statistical power. Real-World Data: Reflects routine clinical practice, making findings highly generalizable. Recommendations for Improvement Complication Analysis: Compare outcomes of patients who suffered adverse events (infection/dislocation) against uncomplicated cases to see how "robust" the recovery is when things go wrong. Age Stratification: Analyze results by age groups to account for differing physiological reserves and lifestyle expectations (e.g. return to work vs. simple pain-free walking). Etiology Focus: Specifically explore the 47.5% of the cohort with secondary OA (systemic inflammatory disease), as this represents a novel contribution to existing literature. Long-term Outlook: Explicitly state in the conclusion that while 2-3 year results are excellent, long-term follow-up is required to monitor potential degradation due to implant wear or aging. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: The article shows the results of hip arthroplasty using functional scores with a record of complications (results that can be compared with other series). I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Jenzri M. Reviewer Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448064 ) The direct URL for this report is: https://f1000research.com/articles/14-792/v1#referee-response-448064 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ben Fredj A. Reviewer Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448067 ) The direct URL for this report is: https://f1000research.com/articles/14-792/v1#referee-response-448067 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Jan 2026 Aymen Ben Fredj , IBN EL JAZZAR University Hospital, Kairouan, Tunisia Approved VIEWS 0 https://doi.org/10.5256/f1000research.186116.r448067 This retrospective study evaluates functional and quality of life outcomes in 200 patients who underwent total hip arthroplasty for hip osteoarthritis, with a minimum follow-up of two years. Using validated functional, physical, psychological, and sleep-related outcome measures (PMA, SF-12, HOOS, ... Continue reading READ ALL This retrospective study evaluates functional and quality of life outcomes in 200 patients who underwent total hip arthroplasty for hip osteoarthritis, with a minimum follow-up of two years. Using validated functional, physical, psychological, and sleep-related outcome measures (PMA, SF-12, HOOS, PSQI, and HADS), the authors demonstrate significant postoperative improvements across all assessed domains and identify factors associated with better outcomes. The manuscript is clearly written, well structured, and supported by relevant and up-to-date literature. The study design is appropriate for the research objectives, and the methodology is technically sound. The inclusion/exclusion criteria, outcome measures, and data collection procedures are adequately described, allowing reproducibility. The statistical analyses are appropriate and correctly interpreted. Results are presented clearly and support the conclusions drawn. Source data availability and ethical considerations are properly addressed. Strengths of this study include the relatively large sample size, use of multiple validated outcome instruments, and a comprehensive assessment of functional and quality-of-life outcomes. The limitations, notably the retrospective design and absence of a control group, are appropriately acknowledged and do not undermine the scientific validity of the study. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Hip and knee surgery, including total hip arthroplasty and surgical management of hip osteoarthritis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ben Fredj A. Reviewer Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448067 ) The direct URL for this report is: https://f1000research.com/articles/14-792/v1#referee-response-448067 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 15 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 15 Aug 25 read read Aymen Ben Fredj , IBN EL JAZZAR University Hospital, Kairouan, Tunisia Mourad Jenzri , MT Kassab Orthopaedic Institute, Tunis, Tunisia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Jenzri M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Mar 2026 | for Version 1 Mourad Jenzri , MT Kassab Orthopaedic Institute, Tunis, Tunisia 0 Views copyright © 2026 Jenzri M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Title: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. Reviewing assessment: Approved Executive Summary The study investigates the functional and psychological outcomes of THA with a minimum two-year follow-up. Using a wide battery of validated tools (PMA, HOOS, SF-12, PSQI, and HADS), the authors demonstrate significant improvements in: Physical Function: Substantial gains in mobility and hip-specific scores. Quality of Life: Enhanced general health perception. Well-being: Notable reductions in sleep disturbances, anxiety, and depression. Key Strengths Holistic Assessment: Moves beyond simple joint function to include mental health and sleep. Sample Size: 200 cases provide strong statistical power. Real-World Data: Reflects routine clinical practice, making findings highly generalizable. Recommendations for Improvement Complication Analysis: Compare outcomes of patients who suffered adverse events (infection/dislocation) against uncomplicated cases to see how "robust" the recovery is when things go wrong. Age Stratification: Analyze results by age groups to account for differing physiological reserves and lifestyle expectations (e.g. return to work vs. simple pain-free walking). Etiology Focus: Specifically explore the 47.5% of the cohort with secondary OA (systemic inflammatory disease), as this represents a novel contribution to existing literature. Long-term Outlook: Explicitly state in the conclusion that while 2-3 year results are excellent, long-term follow-up is required to monitor potential degradation due to implant wear or aging. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise The article shows the results of hip arthroplasty using functional scores with a record of complications (results that can be compared with other series). I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Jenzri M. Peer Review Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448064) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-792/v1#referee-response-448064 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Ben Fredj A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Jan 2026 | for Version 1 Aymen Ben Fredj , IBN EL JAZZAR University Hospital, Kairouan, Tunisia 0 Views copyright © 2026 Ben Fredj A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This retrospective study evaluates functional and quality of life outcomes in 200 patients who underwent total hip arthroplasty for hip osteoarthritis, with a minimum follow-up of two years. Using validated functional, physical, psychological, and sleep-related outcome measures (PMA, SF-12, HOOS, PSQI, and HADS), the authors demonstrate significant postoperative improvements across all assessed domains and identify factors associated with better outcomes. The manuscript is clearly written, well structured, and supported by relevant and up-to-date literature. The study design is appropriate for the research objectives, and the methodology is technically sound. The inclusion/exclusion criteria, outcome measures, and data collection procedures are adequately described, allowing reproducibility. The statistical analyses are appropriate and correctly interpreted. Results are presented clearly and support the conclusions drawn. Source data availability and ethical considerations are properly addressed. Strengths of this study include the relatively large sample size, use of multiple validated outcome instruments, and a comprehensive assessment of functional and quality-of-life outcomes. The limitations, notably the retrospective design and absence of a control group, are appropriately acknowledged and do not undermine the scientific validity of the study. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Hip and knee surgery, including total hip arthroplasty and surgical management of hip osteoarthritis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ben Fredj A. Peer Review Report For: Functional impact and quality of life after total hip arthroplasty for hip osteoarthritis. A retrospective study of 200 cases. [version 1; peer review: 2 approved] . F1000Research 2025, 14 :792 ( https://doi.org/10.5256/f1000research.186116.r448067) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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