Health Status After Total Hip Arthroplasty: A Literature Review

Abstract

Total hip arthroplasty (THA) is the definitive treatment for end-stage hip osteoarthritis, reliably relieving pain and restoring joint function. However, patient-reported quality of life (QoL) after THA remains heterogeneous, with recovery trajectories influenced by a range of biological, psychological, and social factors. A comprehensive synthesis of these determinants is lacking, limiting our ability to optimize individualized perioperative care and long-term outcomes. This review examines the various factors impacting quality of life (QoL) before and after hip arthroplasty. An analysis of 67 studies reveals significant postoperative enhancements in physical function, pain alleviation, and overall patient satisfaction. Identified key factors encompass physical activity, mental health status (anxiety and depression), lifestyle choices (diet and weight management), and social support systems, particularly from spouses and family members. The review indicates that, although these elements positively influence recovery, it also recognizes limitations including dependence on subjective, self-reported QoL measures, possible selection biases, and inconsistencies in study design. The results indicate that a com-prehensive, patient-focused strategy—integrating organized rehabilitation, psychological assistance, and family engagement—can markedly improve recovery and long-term QoL for arthroplasty patients. Nonetheless, additional research employing standardized protocols and extended follow-up durations is essential to corroborate these findings and guide clinical practice. The early implementation of tailored, multidisciplinary perioperative pathways—including structured rehabilitation programs, routine psychological screening and intervention, nutritional counseling for weight management, and active family involvement—may optimize functional recovery, reduce complications, and maximize long-term QoL in patients undergoing THA. This review highlights the importance of a multidisciplinary approach to enhance post-surgical quality of life, thereby advancing the understanding of patient-centered recovery strategies in orthopedic care.

1. Introduction

Coxarthrosis, also known as hip osteoarthritis, is a degenerative joint disease that significantly impacts the quality of life (QoL) of affected individuals. As the disease progresses, patients often experience chronic pain, reduced mobility, and functional impairment, which can severely restrict their daily activities and overall well-being [1].

Total hip arthroplasty (THA), or hip replacement surgery, is a widely accepted and effective treatment for end-stage coxarthrosis, aimed at alleviating symptoms and improving patients’ physical function [2]. In this surgical procedure, the damaged parts of the hip joint are replaced with artificial components made of durable materials such as metal and plastic. The surgery involves removing the damaged cartilage and bone, reshaping the hip socket, and placing the artificial hip joint accurately. With advancements in medical technology, THA has become a routine and successful procedure, providing long-term relief to patients suffering from severe coxarthrosis. The postoperative recovery period typically involves physical therapy and rehabilitation exercises to enhance muscle strength and mobility [3]. Following surgery, patients experience a significant reduction in pain, an increase in joint motion, and improved functionality, enabling them to resume their daily activities with ease.

However, it is important to note that THA is not suitable for all individuals with hip osteoarthritis. Factors such as age, overall health, and the severity of the disease are taken into consideration before recommending this procedure [4]. Additionally, like any surgical intervention, THA carries certain risks and complications, including infection, blood clots, dislocation, prosthetic loosening, and nerve damage. The aging of the population increases healthcare costs, especially for long-term and home care, with average elderly healthcare expenses reaching $48,101 in 2015 [5].

The etiology of coxarthrosis, however, is multifactorial, with causes ranging from primary osteoarthritis, where no specific underlying cause is identified, to secondary coxarthrosis, which arises from conditions such as hip dysplasia, trauma, or inflammatory joint diseases [6]. These etiological differences may influence the progression of the disease, the patient’s preoperative condition, and the postoperative outcomes of total hip arthroplasty (THA). Understanding the various factors contributing to the development and progression of coxarthrosis is crucial in optimizing the management and treatment strategies for affected individuals. With advancements in medical research and collaborative efforts between healthcare professionals, the understanding of coxarthrosis etiology continues to expand, leading to better diagnostic accuracy and more effective treatment modalities [7,8]. As such, ongoing research is essential in unraveling the intricate mechanisms underlying coxarthrosis development and further enhancing the therapeutic options available.

This literature review explores the influence of the etiology of coxarthrosis on patients’ quality of life during both the preoperative and postoperative phases of total hip arthroplasty. By analyzing existing studies, this review aims to assess whether the underlying cause of coxarthrosis plays a significant role in determining the patient’s recovery trajectory, functional improvement, and overall QoL following THA. Understanding these relationships is crucial for optimizing treatment strategies and improving patient outcomes.

In the etiology of coxarthrosis, genetic predisposition, age features, district factors, metabolic factors, and other forms of micro-damage to the joint cartilage system play an important role. Additionally, there is an agreement that genetically determined factors largely play a leading role in primary osteoarthrosis [9]. There are two factors for the development of coxarthrosis: hip joint dysplasia and instability.

2. Materials and Methods

This literature review was conducted in the following scientific databases: Pub-Med, MEDLINE, the Cochrane Library, Scopus, and Web of Science. The search was performed on the full texts of articles. We used a specific protocol for data extraction that included the following information regarding the studies: (1) the assessment of QoL of each included study; (2) the characteristics of the population sampled; and (3) patients preparing for THA or who have undergone the THA procedure.

2.1. Search Strategy

We strategically used the following search phrases including “Etiology of coxarthrosis AND total hip arthroplasty”, “quality of life AND total hip replacement”, “patient reported outcomes AND hip replacement surgery”, “HRQoL AND THA postoperative care”, “preoperative quality of life AND hip replacement”, and “hip osteoarthritis etiology AND pre- post-surgery outcome”.

2.2. Inclusion Criteria

• Study design: quantitative or qualitative original research.
• Language: published in English.
• Availability: full text accessible.
• Population: adult patients (≥18 years) preparing for or having undergone total hip arthroplasty (THA).
• Outcomes: reporting on health-related quality of life (QoL) before and/or after THA.
• Age group: studies restricted to pediatric populations.

2.3. Exclusion Criteria

• Duplicate reports or overlapping datasets.
• Abstracts, conference proceedings, or protocols without full text.
• Reviews, meta-analyses, editorials, commentaries.
• Anatomical focus: interventions targeting joints other than the hip (e.g., knee, shoulder).
• Patient population: non-arthroplasty indications (e.g., cerebral palsy).
• Outcomes: studies evaluating postoperative endpoints unrelated to QoL (e.g., fracture healing, infection rates, prosthesis mechanics).

2.4. Data Synthesis and Analysis

The studies were analyzed to assess the improvement in QoL after surgery, particularly focusing on how these outcomes are influenced by the underlying etiology or patient complaints. Each study included in the analysis was examined to identify the conditions being treated, such as osteoarthritis or other joint-related issues, and the corresponding surgical interventions. By comparing the reported QOL before and after surgery, the studies provide valuable insights into how different etiologies affect recovery and patient satisfaction. This approach allows for a comprehensive understanding of how specific conditions or complaints, such as pain or mobility limitations, impact the overall effectiveness of surgery in improving patients’ quality of life. The focus on QOL outcomes across diverse patient populations and conditions helps highlight the role of personalized treatment approaches in achieving optimal results.

3. Etiology of Coxarthrosis

The most common reason for total hip arthroplasty is osteoarthritis, which accounts for almost 90% of all cases. In comparison, avascular necrosis occurs in only 3–15% of patients. The remaining reasons include previous trauma (4%), hip joint dysplasia (4%), and rheumatoid arthritis (2% of cases) [10]. The second most common etiological factor of hip joint coxarthrosis is considered to be avascular necrosis of the femoral head, which occurs with an incidence of 12–35 cases per 100,000 population per year. The third most common cause of primary coxarthrosis is the residual effects of diseases or injuries affecting the hip joint [11,12]. Considering the prevalence of the population, genetic abnormalities are found in individuals suffering from hip joint dysplasia in 1 case per 1000 live births [13].

The rarity of genetic predisposition to primary hip joint osteoarthritis is undeniable. The incidence of hip joint osteoarthritis, which occurs at a relatively young age, is influenced by other factors, such as the onset of childhood inactivity, mechanical stress as a result of industrial labor, and overweight, all of which affect the articular cartilage and subchondral periarticular structures [14,15]. The main risk factors for the development of hip joint osteoarthritis changes include genetic predisposition and local disturbance of the cartilage surface caused by surgical intervention following injuries. Small intra-articular fractures, malintegration of the hip joint following developmental dysplasia, and acetabular or femoral complications during changes also promote secondary osteoarthritis [16]. In the elderly, the causes of hip joint coxarthrosis include age-related changes in the joints of the lower extremities, which eventually lead to degenerative lesions in all articular structures of the joint.

4. Total Hip Arthroplasty (THA)

THA remains the standard treatment for primary and secondary coxarthrosis. Osseocartilaginous defects in the hip joint are often a common etiologic factor for the development of coxarthrosis; the joint retains mobility. THA surgery involves a patient who undergoes the procedure after comprehensive evidence-based preparation [17]. The main objective of the joint replacement surgery is the reconstruction of support and movement, along with the elimination of pain. The patient’s approval for THA follows the examination of the results of treatment of hip joint illness, based on a properly compiled information letter in which the procedure is described, including the possible complications that may occur, the anesthesia risks, and the anticipated outcome. In addition, modifications of the ‘fast track’ program can be appropriate for preoperative patient preparation for THA [18,19]. Preoperative factors, including the surgical approach and patient characteristics, significantly influence early mobilization and the length of hospital stay (LOS). A recent study demonstrated that the anterior approach was associated with shorter LOS compared to the traditional lateral approach, with factors such as age and the surgical approach impacting mobilization outcomes [20]. In a recent retrospective study, it was shown that the COVID-19 pandemic led to a significant reduction in hospitalization duration for patients undergoing THA with either cemented or cementless prostheses, highlighting the importance of optimizing preoperative evaluation to improve patient outcomes [21].

Implantation of a joint endoprosthesis is an effective option for treating advanced stage coxarthrosis and dysplastic coxarthrosis, which is most often unilateral. Hip replacement at the ten-year mark creates a good long-term result for the treatment of these illnesses. At the same time, when choosing a coated hip joint endoprosthesis at an advanced age, prolonged observation reveals a high percentage of patients with aseptic loosening of the implant, as well as peri-joint fractures if there are low levels of osseointegration [22]. Long-term results should be associated with the increased age of such patients at the time of operation. Preoperative preparation of the patient sets goals in order to improve the perioperative function of patients, as well as to achieve a quicker return to everyday life, not only after the accident but also after the hip endoprosthesis [23].

5. QoL Assessment

The concept of quality of life is multidimensional, and its assessment includes the self-assessment and evaluation of patients. Various domains can be measured: physical, occupational, social, and psychological functioning; physical symptoms; social interaction; and emotional well-being [24,25]. This approach is gaining importance within the evaluation of hip arthroplasty. Indeed, the initial evaluation barometer for patients with hip arthritis was to eliminate the pain and restore their function, and did not take into account their quality of life. The usual orthopedic and rehabilitation evaluation systems are often based on surgical targets, measuring and summarizing the results through criteria such as range of motion, gait, muscle strength, and patient self-assessment [26].

The assessments of the quality of life (QoL) in patients with hip coxarthrosis and those undergoing total hip arthroplasty (THA) are typically conducted using a range of validated tools. One of the most widely used instruments is the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which assesses pain, stiffness, and physical function, specifically in patients with osteoarthritis. The Harris Hip Score (HHS) is another commonly used tool that evaluates hip function, including pain, gait, and range of motion, and is particularly relevant for postoperative assessment after THA. Additionally, the Short Form-36 (SF-36) is a generic health-related quality of life measure that examines both physical and mental health domains, providing a broader perspective on the patient’s well-being. The Hip Disability and Osteoarthritis Outcome Score (HOOS) is also frequently used and is designed to assess symptoms and functional limitations in patients with hip osteoarthritis, including those who have undergone THA. Each of these tools offers insights into different aspects of patient health, allowing clinicians to comprehensively evaluate the impact of coxarthrosis and the effectiveness of THA on overall QoL [27,28,29]. In a retrospective study of 203 participants undergoing THA, the SF-36 was shown to be a specific, useful, and inexpensive tool for evaluating outcomes, particularly in functional outcome scores relative to coxarthrosis etiology [30].

6. Results

Through a rigorous database search, a total of 4884 papers were initially identified. After removing 2150 duplicates, 2638 studies were excluded as they did not meet the inclusion criteria upon review.

Following an assessment of titles and abstracts, 96 studies were selected for further evaluation in a full-text format. Additionally, during the secondary screening, reports were excluded if they were only available as abstracts (n = 23) or study protocols (n = 6). Consequently, only 67 papers were deemed suitable for inclusion in this review (Figure 1).

6.1. Preoperative Quality of Life in Coxarthrosis Patients

Across the included studies, a recurring theme is the profound negative impact of chronic pain on the physical and mental health of patients before surgery. Osteoarthritis, in particular, is associated with significant discomfort, reduced mobility, and diminished quality of life. Patients frequently report feeling anxious, depressed, and socially isolated due to their inability to engage in normal activities. Moreover, psychological factors, such as pain catastrophizing, play a critical role in shaping patients’ preoperative mental health, contributing to heightened distress and lower expectations of surgical outcomes. The combination of these physical and emotional burdens underscores the importance of preoperative assessments and support to improve both physical and mental health outcomes after surgery.

Twenty-two of the sixty-seven studies included in this review provide an assessment of preoperative quality of life (QoL). These studies evaluate patients’ initial health-related quality of life or functional status prior to total hip arthroplasty, facilitating comparative analysis of postoperative outcomes.

Aalund PK et al. observed that preoperative health-related quality of life significantly influences postoperative outcomes, indicating that patients with elevated baseline quality of life frequently exhibit minimal enhancements following surgery. This insight emphasizes the necessity of assessing and establishing realistic expectations for patients with initially elevated QoL scores [31].

Moreover, the study by Chojnowska J. et al. featured a longitudinal analysis, with results indicating that enhancements in quality of life and functional status are maintained over time following total hip arthroplasty. This study indicates that QoL assessments offer thorough insight into patient progress over prolonged durations, which is essential for formulating long-term care strategies [32].

A study conducted by Mariconda and associates revealed that the initial quality of life assessments may predict postoperative recovery trajectories. Patients with diminished preoperative quality of life exhibited more significant improvements in quality of life following surgery, underscoring the transformative effect of total hip arthroplasty on individuals with inferior health conditions. This evidence indicates that THA may be a particularly effective intervention for patients with a low baseline quality of life [33].

These studies demonstrated the distinct advantages of preoperative rehabilitation on postoperative quality of life, particularly in improving mental and physical preparedness for surgery. They suggest that addressing quality of life prior to surgery may facilitate quicker recovery and improved postoperative results for patients. Moreover, physiological factors, such as vitamin D levels, play a significant role in tissue maintenance and healing. A study on patients undergoing facelifting demonstrated that optimal vitamin D levels are associated with maintaining subcutaneous tissue volume and elasticity, which may also have implications for improving recovery and outcomes in other surgeries, including orthopedic interventions [34]. Moreover, psychological factors, such as pain catastrophizing, play a critical role in shaping patients’ preoperative mental health, contributing to heightened distress and lower expectations of surgical outcomes. Anxiety disorders are among the most prevalent mental health issues in children and adolescents, and although they are not the focus here, similar issues in adult populations can impact recovery and response to surgical interventions (

Table 1. Key studies on preoperative quality of life.

Study	Population	Tools/Measures	Key Findings
10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study [36]	588 participants aged 45–65	Physical exams, clinical criteria for OA	Pain and stiffness increased over 10 years; medication use trends varied based on risk groups.
Health-related QoL in patients waiting for major joint replacement [37]	133 patients awaiting surgery	15D questionnaire	HRQoL worse than controls; no deterioration while waiting, but BMI and baseline 15D scores influenced admission outcomes.
The effect of waiting time on health-related QoL [38]	312 patients	15D, HHS, ADL scores	No significant difference in HRQoL based on waiting time.

) [35].

6.2. Postoperative QoL in Coxarthrosis Patients

The main purpose and indicator of successful treatment in osteoarthritis patients after THR remains the evaluation of quality of life by comparing pre- and post-surgical data. The evaluation is carried out using different questionnaires, including specific and nonspecific systems, such as a general version of patient evaluation, and questionnaires that provide a more detailed overview of the patients’ complaints. The use of a number of questionnaires will help improve the reliability of a painless or painful state of operated joints. In some studies, the comparison of the quality of life of osteoarthritis patients after THA was carried out with large groups of patients with the same diagnosis who refused to perform THA for various reasons. Such studies focus primarily on the economic effect of the refusal to perform total joint replacement.

Our review describes the results of the development of the quality of life of patients with various etiologies of hip arthrosis, including the influence of different treatment methods on their quality of life in the preoperative and postoperative phases of total hip arthroplasty.

Our analysis underscores substantial long-term enhancements in quality-of-life post-surgery, evidenced by improved mobility, diminished pain, and increased functional capacity. Research utilizing the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and SF-36 instruments indicates elevated scores in physical health domains following surgery, especially in pain management and physical function. Loures et al. demonstrate considerable enhancement in health-related quality of life for patients with osteoarthrosis following total hip arthroplasty (THA), as indicated by SF-36 and Harris Hip Score evaluations, especially in physical and social domains [39]. Moreover, a long-term follow-up study conducted by Mariconda et al. (average of 16 years post-THA) reveals high patient satisfaction (96%) and enhanced functionality, as assessed by SF-36 and WOMAC scores, along with significant physical and pain relief benefits reported [33].

Expedited and organized perioperative rehabilitation programs demonstrate favorable outcomes in the short-term recovery period. Participants in these programs indicate a decreased length of hospital stay (LOS) and enhanced quality of life (QoL) scores within three months following surgery, in contrast to standard care, implying that early, intensive rehabilitation can accelerate recovery and improve postoperative results [36,40].

Research examining the effects of lifestyle factors, including alcohol consumption and obesity, indicates that these may affect postoperative quality of life. Moderate alcohol consumption is associated with improved WOMAC scores, whereas obesity is correlated with extended recovery times and diminished physical function scores following surgery. These findings highlight the significance of lifestyle modifications in preoperative preparation [41,42].

Age significantly influences postoperative quality of life outcomes. Certain studies indicate that older patients exhibit marginally reduced improvements in quality of life, especially in physical aspects, relative to younger patients. Nonetheless, enhancements in pain and mental health are typically observed across various age demographics, suggesting that even geriatric patients derive substantial benefits from surgical intervention [31,43].

Psychological well-being, encompassing mental health scores, also shows improvement after surgery, although these gains are often less pronounced than physical enhancements. Additionally, research highlights the crucial role of social support in recovery, as patients receiving familial or community assistance report higher quality of life scores [44,45]. Return to sports outcomes exhibited significant variability (20–98.5%). Most studies indicated improved survivorship among high-activity patients. High-activity participants had all-cause revision rates ranging from 0.9% to 8.57% and aseptic revision rates from 0.4% to 5.7%. In contrast, low-activity participants had all-cause revision rates between 0.7% and 3.4% and aseptic revision rates from 0.0% to 2.1%. There was no clear link between activity level and dislocation rates. Positive correlations between post-THA activities and enhanced mental health and patient satisfaction were noted [46]. Beyond osteoarthritis, hip arthroplasty is increasingly performed for end-stage ankylosing spondylitis (AS), a spondyloarthropathy characterized by synovitis, enthesial inflammation, and progressive secondary osteoarthritis of the hip. AS patients face unique perioperative challenges, including preoperative surgical planning for fixed flexion deformities, customized thromboprophylaxis, anesthetic considerations in a hypokinetic spine, and the risk of heterotopic ossification. Nevertheless, they report significant postoperative improvements in the range of motion, pain relief, and overall survivorship comparable to osteoarthritis cohorts [47]. Despite good success rates, some patients do not achieve favorable functional outcomes, making preoperative identification important. Most working patients preoperatively return to work after recovery, but lack guidance from clinicians about returning (

Table 2. Studies on postoperative QoL improvements.

Study	Population	Tools/Measures	Key Findings
QoL and functionality after total hip arthroplasty: a long-term follow-up study [33]	250 patients (11–23 years postop)	SF-36, Harris Hip Score, WOMAC	High satisfaction rates (96%); hip functionality and comorbidities were key determinants.
Excellent Functional Outcome and QoL after Primary Cementless THA Using an Enhanced Recovery Setup [49]	109 patients	Harris Hip Score, WOMAC, EQ-5D	Significant QoL improvements at 4 weeks and 12 months postop.
The impact of age and preoperative HRQoL on improvements after THA [31]	1283 cases	PROMs, EQ-5D	Older patients had better HRQoL improvements; high preoperative HRQoL inhibited further improvement.

) [48].

6.3. Comparisons of QoL Between Preoperative and Postoperative Phases

Total hip arthroplasty (THA) is a procedure that provides pain relief, improves hip function, and enables patients to maintain an independent life. The etiology of coxarthrosis may have an impact on the intensity of the patient’s psychological state or on the decrease in the quality of life (QoL) of the patient even before the surgery.

The studies included in this review indicate that comparisons of preoperative and postoperative quality-of-life (QoL) assessments demonstrate significant enhancements in physical, functional, and psychological dimensions for patients after orthopedic surgery. Research on hip arthroplasty indicated significant postoperative quality-of-life enhancements across various domains. The physical health score, assessed using the SF-12 scale, exhibited substantial increases, frequently exceeding one standard deviation on average, signifying the notable alleviation of pain and improved physical function following surgery [45]. Correspondingly, functional enhancements were evident in the EQ-5D scores, where diminished preoperative function scores resulted in more significant postoperative advancements, underscoring the surgery’s efficacy in mitigating limitations related to severe osteoarthritis [31].

Patients with multiple comorbidities reported relatively diminished quality-of-life improvements postoperatively, indicating that chronic conditions may attenuate the perceived benefits of surgery. A study by Zhang L. et al. indicated that although patients undergoing THA and TKA with comorbidities experienced improvements, their quality-of-life enhancements were less significant compared to those of healthier patients. This effect was especially pronounced in the mental health scores, where the postoperative enhancements were less significant compared to their physically healthier counterparts [50].

Subsequent research indicated that older patients exhibited more limited enhancements in specific quality-of-life domains relative to younger patients. Although age did not inherently restrict the advantages in physical functionality, the mental health scores of older patients exhibited a diminished level of improvement, possibly attributable to a higher baseline of functional limitations or varying psychological reactions to surgery [37].

6.4. Factors Influencing QoL in Coxarthrosis Patients

The severity of coxarthrosis correlates with the patient’s quality of life. The characteristic feature of this hip joint disorder is the regular necessity of surgical treatment in the form of total hip arthroplasty.

Physical activity was identified as a crucial determinant affecting quality of life following surgery. Patients who participated in regular physical exercise demonstrated improved physical functionality and diminished joint stiffness, as evidenced by WOMAC scores in studies evaluating postoperative recovery. Also, consistent physical activity markedly enhanced patient outcomes, implying that preoperative physical limitations could be alleviated through organized postoperative physical therapy [32,51,52].

The psychological factors of anxiety and depression significantly affect the quality of life in these patients. Depression scores, assessed using the CES-D, were utilized to evaluate mood-related quality-of-life implications. Patients exhibiting elevated pre-surgical depression levels frequently reported inferior quality-of-life outcomes post-surgery, as demonstrated by the EQ-5D assessments. This trend highlights the necessity of mental health support for these patients, as depressive symptoms can impede physical rehabilitation and overall quality-of-life enhancement [53,54,55].

The nutritional status, encompassing obesity and dietary quality, was correlated with quality-of-life outcomes. Research demonstrated that obesity adversely affected recovery, with patients exhibiting elevated BMI experiencing prolonged mobility improvements and increased pain scores following surgery. Obese patients exhibited lower scores in the SF-36 physical function domain than individuals within healthier weight ranges. This finding indicates a significant correlation between diet, body weight, and recovery outcomes, highlighting the necessity of dietary management prior to and following surgery [56,57,58].

Spousal social support markedly enhanced positive quality-of-life outcomes. Married patients or those residing with family exhibited greater satisfaction and improved recovery, as social support is essential for sustaining motivation and compliance with rehabilitation programs. Research indicated that patients receiving spousal support achieved superior scores in the social and emotional domains of the SF-36, thereby facilitating improved overall recovery and enhanced quality of life [46,59]. Patient satisfaction is a key outcome following primary THA. While THA relieves pain and restores function, 7 percent of patients remain dissatisfied. Satisfaction levels depend on preoperative expectations, patient demographics, pain management effectiveness, comorbidities, and hospital stay duration. To address this gap, THA programs should implement the systematic collection of patient satisfaction data using validated scales [60].

A study of 433 adults undergoing THA for osteoarthritis was conducted at a tertiary hospital in New Zealand between 2017 and 2020. Participants completed measures of pain, function, and quality of life (QOL) before surgery and at 6 and 12 months post-THA. Clinically significant improvements in pain and function were associated with enhanced QOL, independent of preoperation scores. Major improvements occurred from pre-operation to 6 months post-operation. While gender and comorbidities showed no correlation with QOL changes, age at surgery had a modest negative correlation. THA led to significant improvements in QOL, pain, and function, with these improvements being interrelated and somewhat moderated by age (

Table 3. Key factors influencing QoL in coxarthrosis patients.

Study	Population	Etiology	Key Findings	QOL Assessment Tools
10-Year Natural Course of Early Hip Osteoarthritis (CHECK Study) [36]	588 participants aged 45–65 with hip pain	Not specified	Physical function decreased significantly over 10 years; medication use varied based on radiographic OA (ROA) presence.	WOMAC, EQ-5D
Accelerated Perioperative Care and Rehabilitation Intervention [62]	87 patients, 42 control, 45 interventions	Degenerative OA	QOL gain higher in the intervention group (0.42 vs. 0.26); reduced hospital length of stay.	EQ-5D, WOMAC
Age-Related QOL After Total Hip Replacement [43]	4519 patients	Primary OA	Older patients had less improvement in HRQoL; younger patients showed higher gains post-surgery.	EQ-5D, WOMAC
Effect of Nutritional Status on QOL Post-Surgery [42]	206 THRs implanted in morbidly obese	Primary OA	Preop WOMAC scores were significantly lower in obese patients; postop improvements comparable to non-obese patients.	WOMAC, SF-36
Impact of Social Support on Recovery and QOL [63]	29 couples	Primary OA	Spousal support led to enhanced recovery and better QOL improvements in social and family activities.	WOMAC, SF-36
Influence of Depression and Sleep Quality on Post-Op Outcomes [64]	61 patients	End-stage OA	Depression negatively correlated with QOL outcomes; better mental health linked to better recovery.	SF-36, WOMAC
Physical Activity and Functional Recovery After THA [40]	100 patients	Primary OA	Physiotherapy improved functional outcomes significantly in elderly patients.	Harris Hip Score, WHOQOL-BREF
Effects of Fasting and Dietary Changes During Rehabilitation [56]	125 patients	Primary OA	Modified fasting reduced pain and stiffness by 40%; highlighted dietary influence on recovery.	WOMAC
Exercise Therapy and QOL Improvements [65]	225 patients	Primary OA	Exercise adherence associated with better pain management, physical function, and self-reported effect.	WOMAC, SF-36
Impact of Early Rehabilitation on Patient Satisfaction [32]	147 patients	OA (Not specified)	Early rehabilitation reduced disability; acceptance of disease improved QOL in 95% of cases.	Barthel Index, WHOQOL-BREF, HHS

) [61].

7. Discussion and Implications for Clinical Practice

Hip osteoarthritis is one of the most common diseases in the world. Estimations indicate that, between 1990 and 2016, the global age-standardized prevalence of hip osteoarthritis increased by 26.5% [25,66]. This alarming increase in prevalence calls for a thorough understanding of the disease, its etiology, and its impact on patients’ quality of life. The etiology of hip osteoarthritis plays a crucial role in determining the quality of life experienced by patients at every phase until treatment is initiated [67].

Numerous studies have explored the causes of hip osteoarthritis, highlighting various factors that contribute to its development. These factors not only encompass biological aspects but also socio-demographic factors such as sex, age, body mass, and level of physical activity. All these factors have been found to have a significant influence on the risk of developing the disease [68,69]. Furthermore, an in-depth analysis of the quality of life experienced by patients reveals several disadvantages resulting from coxarthrosis and the preoperative and postoperative periods of total hip endoprosthesopathy. These disadvantages manifest in various aspects of patients’ lives, including physical functioning, pain levels, emotional well-being, social activities, and overall satisfaction with life [70].

Fortunately, the implementation of total hip arthroplasty has shown promising results in improving patients’ quality of life. In particular, the postoperative rehabilitation phase has been found to yield the most substantial improvements in various quality-of-life indicators for patients who undergo total hip arthroplasty due to primary and secondary coxarthrosis of the hip [71].

The beneficial effect of physical activity on postoperative quality of life indicates that the incorporation of organized, early rehabilitation programs ought to be a standard element of postoperative care. Rehabilitation programs that promote physical activity have demonstrated efficacy in enhancing mobility, alleviating pain, and increasing physical functionality, all of which are vital for patients’ quality of life [72]. In addition to traditional rehabilitation, regenerative medicine, including cell therapy and tissue engineering methods such as electrospun scaffolds, offers new possibilities for improving bone regeneration and accelerating the recovery of damaged tissues in cases of severe osteoarthritis and bone diseases [73]. Clinicians ought to promote these programs as integral components of a holistic recovery strategy and instruct patients on the significance of complying with prescribed exercise protocols. Moreover, the advantages of organized rehabilitation suggest that healthcare providers must collaborate closely with physical therapists to guarantee that patients receive support and oversight during their recovery process [74].

The considerable impact of anxiety and depression on patient outcomes underscores the necessity for psychological evaluations and support within pre- and post-surgical care protocols. Individuals exhibiting elevated anxiety or depression levels generally experience inferior quality-of-life outcomes, indicating that mental health interventions may be pivotal in facilitating recovery [75]. Conducting regular psychological assessments and providing access to counseling or mental health services may alleviate these effects. For patients displaying elevated preoperative anxiety, preemptive measures may include consultations with mental health professionals to alleviate their concerns and psychologically prepare them for the surgical and recovery processes [76].

The influence of diet and obesity on quality of life post-surgery underscores the importance of preoperative weight management and dietary guidance. Obesity and inadequate dietary practices correlate with prolonged recovery and complications, underscoring the necessity for dietary interventions in preoperative preparation. Clinicians must identify at-risk patients promptly and offer resources for nutritional counseling. Patients may benefit from specialized guidance on weight reduction and improved nutritional habits, preferably commencing prior to surgery and persisting postoperatively to facilitate optimal results [77,78].

The significance of social support, especially from spouses, highlights the critical role of family engagement in the recovery process. Clinicians ought to promote the involvement of family members in the rehabilitation process, as patients with robust familial support systems achieve superior physical and psychological outcomes. This may entail providing family counseling sessions or workshops on how family members can aid in daily activities, promote compliance with rehabilitation exercises, and offer emotional support [79]. Encouraging social engagement among older adults can cultivate a supportive community environment that enhances their recovery and quality of life.

Integrating these findings into clinical practice necessitates a transition to a more comprehensive, patient-centered care model that addresses the diverse needs of arthroplasty patients. Conducting preoperative evaluations that encompass lifestyle, mental health, and social determinants will enable clinicians to customize interventions to specific patient profiles. Establishing multidisciplinary care teams comprising physical therapists, dietitians, and mental health professionals may offer patients a more integrated support system during their surgical experience.

Upon examining the studies regarding quality-of-life (QoL) outcomes following hip and knee arthroplasty, numerous biases and limitations are apparent. A principal limitation is the dependence on self-reported quality-of-life measures, such as the SF-36 and WOMAC, which are subjective and may be affected by patient recall bias or personal expectations regarding surgery. Furthermore, numerous studies utilize cross-sectional or observational methodologies, which constrain the capacity to ascertain causal relationships between variables such as physical activity or psychological support and enhancements in quality of life. Selection bias poses a significant issue, as patients with severe comorbidities or elevated health risks may be under-represented in studies concentrating on standard arthroplasty outcomes, consequently restricting the generalizability of findings to wider patient populations. Furthermore, certain studies possess comparatively brief follow-up durations, potentially failing to adequately reflect the enduring sustainability of quality-of-life enhancements. Ultimately, discrepancies in assessment instruments and variations in rehabilitation protocols among studies contribute to heterogeneity, complicating direct outcome comparisons and the formulation of standardized clinical recommendations. Mitigating these limitations in forthcoming research could strengthen the validity and relevance of QoL findings in this patient demographic support system during their surgical experience.

8. Limitations and Future Directions

Upon examining the studies regarding QoL outcomes post-hip and knee arthroplasty, numerous biases and limitations are apparent. A principal limitation is the dependence on self-reported QoL measures, such as the SF-36 and WOMAC, which are subjective and may be affected by patient recall bias or personal expectations regarding surgery. Furthermore, numerous studies utilize cross-sectional or observational methodologies, which constrain the capacity to ascertain causal relationships between variables such as physical activity or psychological support and enhancements in quality of life. Selection bias poses a significant issue, as patients with severe comorbidities or elevated health risks may be under-represented in studies concentrating on standard arthroplasty outcomes, consequently restricting the generalizability of findings to wider patient populations. Furthermore, certain studies possess comparatively brief follow-up durations, potentially failing to adequately reflect the enduring sustainability of QoL enhancements. Ultimately, discrepancies in assessment instruments and variations in rehabilitation protocols among studies contribute to heterogeneity, complicating direct outcome comparisons and the formulation of standardized clinical recommendations. Mitigating these limitations in forth-coming research could strengthen the validity and relevance of QoL findings in this patient demographic.

9. Conclusions

This review highlights the complex nature of QoL outcomes in total hip arthroplasty patients. Studies show significant postoperative improvements in physical function, pain relief, and patient satisfaction, especially with rehabilitation, psychological support, and family involvement. Factors like physical activity, mental health, lifestyle, and social support are crucial for effective recovery. However, inconsistencies in study design, reliance on self-reports, and short follow-up periods call for more standardized long-term research to improve clinical recommendations. Multi-disciplinary care addressing these factors can enhance both physical and psychosocial recovery in arthroplasty patients.