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Introduction <p>Urinary incontinence (UI), a prevalent quality-of-life–limiting condition, frequently coexists with hip osteoarthritis, potentially through pelvic floor dysfunction related to obturator internus muscle involvement. Several reports suggest improvement after total hip arthroplasty (THA), although postoperative time-course changes remain unclear. This study aimed to clarify the temporal trends in UI after THA and examine association of postoperative UI trajectories with functional recovery.</p> Materials and methods <p>This retrospective study included 118 female patients who underwent THA for hip osteoarthritis between October 2021 and March 2024. UI, assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), was defined as ICIQ-SF ≥ 1 preoperatively and at 3, 6, 9, and 12&#xa0;months postoperatively, and classified as stress (SUI), urge (UUI), or mixed (MUI). Hip-related patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Associations with BMI, age, surgical approach (direct lateral/Bauer vs. modified Watson-Jones/OCM), and UI type were tested using Mann–Whitney U, chi-squared, and repeated-measures ANOVA tests.</p> Results <p>Of 118 patients (mean age at surgery, 67&#xa0;years; mean BMI, 24.3&#xa0;kg/m<sup>2</sup>) preoperatively, 73 (61.9%) reported UI (mean ICIQ-SF 7.88), including SUI (n = 20), UUI (n = 26), and MUI (n = 27), with a higher baseline severity in MUI than in UUI. The mean ICIQ-SF improved markedly by 3&#xa0;months (3.88) with a significant time effect (p &lt; 0.001, η<sup>2</sup> = 0.39), but then plateaued through 12&#xa0;months. Although most patients improved, 45/73 (61.6%) had persistent UI at 12&#xa0;months. These patients had higher preoperative ICIQ-SF and significantly worse postoperative JHEQ (notably pain) across multiple time points, while BMI, approach, and UI type showed no significant group differences.</p> Conclusion <p>UI symptoms improved significantly within the first 3&#xa0;months following THA; however, subsequent recovery was limited. Persistent UI was associated with poorer functional recovery and higher pain levels.</p>

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Trajectory of urinary incontinence symptoms following total hip arthroplasty for hip osteoarthritis

  • 期刊论文

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  • 发表日期：

    2026年7月7日

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  • Masaru Kadowaki,
  • Sayaka Fukutani,
  • Kiminori Ushio,
  • Yuji Uchio

摘要

Introduction

Urinary incontinence (UI), a prevalent quality-of-life–limiting condition, frequently coexists with hip osteoarthritis, potentially through pelvic floor dysfunction related to obturator internus muscle involvement. Several reports suggest improvement after total hip arthroplasty (THA), although postoperative time-course changes remain unclear. This study aimed to clarify the temporal trends in UI after THA and examine association of postoperative UI trajectories with functional recovery.

Materials and methods

This retrospective study included 118 female patients who underwent THA for hip osteoarthritis between October 2021 and March 2024. UI, assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), was defined as ICIQ-SF ≥ 1 preoperatively and at 3, 6, 9, and 12 months postoperatively, and classified as stress (SUI), urge (UUI), or mixed (MUI). Hip-related patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Associations with BMI, age, surgical approach (direct lateral/Bauer vs. modified Watson-Jones/OCM), and UI type were tested using Mann–Whitney U, chi-squared, and repeated-measures ANOVA tests.

Results

Of 118 patients (mean age at surgery, 67 years; mean BMI, 24.3 kg/m2) preoperatively, 73 (61.9%) reported UI (mean ICIQ-SF 7.88), including SUI (n = 20), UUI (n = 26), and MUI (n = 27), with a higher baseline severity in MUI than in UUI. The mean ICIQ-SF improved markedly by 3 months (3.88) with a significant time effect (p < 0.001, η2 = 0.39), but then plateaued through 12 months. Although most patients improved, 45/73 (61.6%) had persistent UI at 12 months. These patients had higher preoperative ICIQ-SF and significantly worse postoperative JHEQ (notably pain) across multiple time points, while BMI, approach, and UI type showed no significant group differences.

Conclusion

UI symptoms improved significantly within the first 3 months following THA; however, subsequent recovery was limited. Persistent UI was associated with poorer functional recovery and higher pain levels.