Abstract
BackgroundUniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery and inappropriateness of care may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip replacement surgery.MethodsPatients with a diagnosis of unilateral or bilateral osteoarthritis were included. Consensus rounds with orthopedic surgeons were organized to blindly reassess medical files and to decide whether surgery is indicated or not, based on all available pre-treatment information. We compared the outcomes obtained from the blind reassessment by the consensus group with the actual treatment. Furthermore, prediction models were fitted on the reassessment outcome to identify which set of clinical parameters would be most predictive and uniformly shared in the decision to operate.Two prediction models were fitted, one model without radiologic outcomes and one model where radiologic outcomes were included.ResultsIn total, 364 medical files of osteoarthritis patients were included and reassessed in the analyses. Key predictors in the prediction model without radiology were age, flexion, internal rotation and the Hip disability and Osteoarthritis Outcome Score–quality of life. The discriminative power was high (Area Under Receiver Operating Curve (AUC) = 0.86). Key predictors in the prediction model with radiology were age, internal rotation and Kellgren and Lawrence severity score (AUC = 0.94).ConclusionThe study yielded a decision tool with uniform criteria for hip replacement surgery in osteoarthritis patients. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context.
Highlights
The number of total hip replacement surgeries per 100 000 inhabitants has substantially increased over the past years worldwide [1]
Diffuse clinical criteria for certain procedures may be important drivers for geographical variation in the over- and underuse of this procedure [2,3,4]. This may be the case for hip replacement surgery, since clinical criteria for total hip replacements are based on limited and low-quality evidence [5]
Several other studies have indicated that there is an important variability in clinical criteria for hip replacements and that decision support tools, to decide which clinical parameters are most indicative of surgery, are imperative [6,7,8]
Summary
The number of total hip replacement surgeries per 100 000 inhabitants has substantially increased over the past years worldwide [1]. A utilization rate of 238 per 100 000 inhabitants was reported for the Netherlands, which places it in the top 10 countries with the highest degree of hip replacement surgeries worldwide [1]. Possible explanations for this increase over time and geographical differences include variation in classification systems and variation in registration practices. In order to reduce unwarranted practice variation and possible over- and underuse of hip replacement surgery, it is crucial to develop indication standards with clear and uniform clinical criteria for hip replacement surgery. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context
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