Hip surgery: evaluation of outcomes in terms of mental and physical health
Hip surgery: evaluation of outcomes in terms of mental and physical health
Hip surgery plays a central role in orthopaedic care, covering elective procedures such as total hip arthroplasty and urgent surgery for hip and femur fractures. While both aim to relieve pain, restore mobility, and improve quality of life, the underlying patient populations differ substantially — in age, comorbidity burden, cognitive status, and treatment goals. These differences also shape how outcomes should best be measured. Patient-reported outcome measures (PROMs) are widely used in elective care, but frail trauma patients are often unable to complete them, leaving domains such as mental health and functional independence underrepresented in this group.
This thesis of Noa Ponds investigates how outcome assessment after hip surgery can be improved, with attention to both physical and mental health across elective and trauma populations.
Part 1 establishes the methodological foundation, evaluating the validity of existing outcome measures, including proxy-reported outcomes and wearable sensor-based performance measures as a complement to PROMs. Both approaches add value, particularly for detecting functional deficits and interpreting subjective domains — though careful interpretation remains essential.
Part 2 focuses on elective hip arthroplasty. A large retrospective study shows improved physical function and shorter hospital stays after transitioning to the direct anterior approach, while a randomized comparison with the posterolateral approach finds similar early recovery between techniques — suggesting surgical choice can be guided by surgeon expertise and patient anatomy rather than assumptions of faster recovery.
Part 3 addresses geriatric trauma care after hip fracture. Despite high mortality, many patients regain ambulatory ability and functional independence, underscoring the value of surgical intervention beyond survival alone. Proxy reporting proves useful, especially for objective outcomes, while subjective domains such as mental health require cautious interpretation.