Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

Paul Dieppe,Klaus-Peter Guenther,David Rowley,Markus Floeren,Joerg Huber,Anna Nilsdotter,L Stefan Lohmander,Ian Learmonth,Ifeoma Ikwueke,Wofhart Puhl,Thorvaldur Ingvarsson,Robert Thieler,Karsten Dreinhoefer,Andrew Judge,Susan Williams

doi:10.1186/1471-2474-10-19

Abstract

BackgroundTotal hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation.MethodsA minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC – Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out.ResultsData from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common.Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores.Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment.Conclusion1. Clinical disease severity varies widely at the time of THR for OA.2. In advanced hip OA clinical severity shows no correlation with radiographic severity.3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR.

Highlights

Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA)
The radiographic severity showed no correlation with WOMAC scores
In advanced hip OA clinical severity shows no correlation with radiographic severity

Summary

Introduction

Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). Total hip replacement (THR) is an effective and cost-effective procedure for people with severe hip osteoarthritis (OA), unresponsive to conservative therapy [1,2] It has become a high volume procedure throughout Europe, and annual rates continue to rise [2,3]. It is generally accepted that the indications for THR are pain and disability in spite of the use of non-surgical interventions such as education, drugs, walking aids and physical therapy [4] It is not clear how severe the pain or disability needs to be before surgery should be undertaken, or when in the course of OA it is most appropriate to perform a THR. The potential implications of operating relatively early or late in the course of the disease are large, as this could have massive effects on the volume of surgery undertaken, as well as on outcomes

Methods

Results

Discussion

Conclusion