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Jayaraju U, Boktor J, Joseph V, Yoganathan S, Elsheikh M, Lewis PM. Outcomes following staged bilateral total hip replacement: does first-side surgery predict the second? Ann R Coll Surg Engl 2024; 106:262-269. [PMID: 37458204 PMCID: PMC10904259 DOI: 10.1308/rcsann.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) for bilateral staged total hip replacements (THRs) were reviewed to determine whether first-side surgery can predict second-side outcomes. METHODS A retrospective review was undertaken of a consecutive cohort of staged bilateral THRs using the same approach, implant and technique, from August 2009 to February 2020. Minimal important change (MIC) in PROMs was set at ≥5. RESULTS A total of 296 consecutive staged bilateral THRs were performed in 148 patients. Mean time interval between sides was 25 months (range 2-102). Mean age was 63.2 years for the first side and 65.3 years for the second; 62.8% of patients were female. Mean body mass index was 31.08 for the first side, increasing to 31.57 for the second side (p = 0.248). One-year follow-up PROMs were available for 96.6% and 92.5% of the first and second side, respectively. Mean PROMs improvement at 1 year was 26.4 for the first side and 25.1 for the second side (p = 0.207). Some 97.9% of patients achieved MIC for the first side and 96.3% for the second side (p = 0.092). Eight patients failed to reach an MIC on one side, all were female (p < 0.001); however, MIC was achieved for the contralateral side. Seven of eight patients (87.5%) achieved MIC by 2 years. CONCLUSIONS This study identified no significant difference between first- and second-side PROMs improvements following staged bilateral THRs at 1-year follow-up. Failure to reach MIC on one side does not preclude success on the other. Female patients were more prone to not reach MIC at 1 year, but improvement was still subsequently achieved in the majority of cases. The informed consent process is able to reflect this expectation.
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Affiliation(s)
- U Jayaraju
- Cwn Taf Morgannwg University Health Board, UK
| | - J Boktor
- Cwn Taf Morgannwg University Health Board, UK
| | - V Joseph
- Cwn Taf Morgannwg University Health Board, UK
| | | | - M Elsheikh
- Cwn Taf Morgannwg University Health Board, UK
| | - PM Lewis
- Cwn Taf Morgannwg University Health Board, UK
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Fujita K, Makimoto K, Tabuchi Y, Matsunaga-Myoji Y, Mawatari M. Oxford Hip Scores, Floor-Sitting Score Trajectories, and Postoperative Satisfaction Rates at 10 Years After Primary Total Hip Arthroplasty. J Arthroplasty 2023; 38:2673-2679. [PMID: 37321523 DOI: 10.1016/j.arth.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Available evidence on outcomes at 5 years and beyond for total hip arthroplasty (THA) is mainly limited to patient-reported outcome measures (PROMs). This study documented the trajectory of functional measurement using the Oxford hip score (OHS) and floor-sitting posture in Japan for up to 10 years post-THA and investigated predictors of dissatisfaction at 10 years with THA. METHODS Patients scheduled for primary THA at a university hospital in Japan between 2003 and 2006 were enrolled in this prospective study. Overall, 826 preoperative participants were eligible for follow-up, with response rates ranging from 93.6% to 69.4% at each postoperative survey point. The OHS and floor-sitting scores were calculated using a self-administered questionnaire 6 times up to 10 years postoperatively. Patient satisfaction, including general surgery, walking ability, and activities of daily living (ADL), was assessed in the 10-year survey. RESULTS The linear mixed-effects model demonstrated a postoperative improvement, peaking at 7 years for OHS and 5 years earlier for the floor-sitting score. The postoperative overall surgical dissatisfaction at 10 years with THA was very low (3.2%). No predictors of surgical dissatisfaction were identified in the logistic regression analyses. Predictors of walking ability dissatisfaction were older age, men, and worse OHS at 1 year postoperatively. Predictors of ADL dissatisfaction were poorer preoperative and 1-year postoperative floor-sitting scores and 1-year postoperative OHS. CONCLUSION The floor-sitting score is a simple PROM suitable for the Japanese population; other populations would require a scale suitable for their lifestyles.
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Affiliation(s)
- Kimie Fujita
- Department of Health Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Makimoto
- Department of Health Sciences, Osaka University, Osaka, Japan
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Harrison CJ, Plessen CY, Liegl G, Rodrigues JN, Sabah SA, Beard DJ, Fischer F. Item response theory assumptions were adequately met by the Oxford hip and knee scores. J Clin Epidemiol 2023; 158:166-176. [PMID: 37105320 DOI: 10.1016/j.jclinepi.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES To develop item response theory (IRT) models for the Oxford hip and knee scores which convert patient responses into continuous scores with quantifiable precision and provide these as web applications for efficient score conversion. STUDY DESIGN AND SETTING Data from the National Health Service patient-reported outcome measures program were used to test the assumptions of IRT (unidimensionality, monotonicity, local independence, and measurement invariance) before fitting models to preoperative response patterns obtained from patients undergoing primary elective hip or knee arthroplasty. The hip and knee datasets contained 321,147 and 355,249 patients, respectively. RESULTS Scree plots, Kaiser criterion analyses, and confirmatory factor analyses confirmed unidimensionality and Mokken analysis confirmed monotonicity of both scales. In each scale, all item pairs shared a residual correlation of ≤ 0.20. At the test level, both scales showed measurement invariance by age and gender. Both scales provide precise measurement in preoperative settings but demonstrate poorer precision and ceiling effects in postoperative settings. CONCLUSION We provide IRT parameters and web applications that can convert Oxford Hip Score or Oxford Knee Score response sets into continuous measurements and quantify individual measurement error. These can be used in sensitivity analyses or to administer truncated and individualized computerized adaptive tests.
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Affiliation(s)
- Conrad J Harrison
- Surgical Intervention Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Constantin Yves Plessen
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jeremy N Rodrigues
- Clinical Trials Unit, University of Warwick, Coventry, UK; Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, Aylesbury, UK
| | - Shiraz A Sabah
- Surgical Intervention Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Surgical Intervention Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Chapot A, Zambelli PY, Merckaert SR. Functional and Patient-related Outcomes of Total Hip Arthroplasty in Patients Younger Than 20 Years. Arthroplast Today 2023; 20:101100. [PMID: 36923059 PMCID: PMC10009676 DOI: 10.1016/j.artd.2023.101100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 03/18/2023] Open
Abstract
Background Total hip arthroplasty (THA) in adolescent and young adults represent only about 10% of all THAs. Despite the advances in hip conservation surgery, there are still adolescents and young adults who progress to severe joint degeneration. THA seems to be the last solution in these cases. We aimed to assess the clinical and patient-related outcomes at short-term to midterm follow-up for THAs performed before the age of 20 years. Material and methods We performed a retrospective monocentric study including all patients that underwent a THA before the age of 20 years between January 2008 and December 2018 at our tertiary orthopaedic center with a minimum follow-up of 2 years. Demographic data were recorded. The Harris and Oxford hip scores were used to assess clinical and patient-related outcomes. Results A total of 11 patients (12 THAs) were included. Juvenile inflammatory arthritis and avascular necrosis due to slipped capital femoral epiphysis were the most commonly encountered etiologies. The mean age at surgery was 16 years (minimum 13, maximum 19 years). The mean follow-up duration was 6 years (minimum 2, maximum 9 years) without any revision. Regarding the Harris and Oxford hip scores, the mean score were 81 and 39.5 for clinical and patient-related outcomes respectively. The Spearman correlation test revealed a statistically significant positive correlation between the 2 scores of ρ = 0.811 with a P value < .001. Conclusions THA in adolescents and young adults suffering from end-stage osteoarthritis due to pediatric hip disorders provides improved hip function and notable pain relief at short-term to midterm follow-up.
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Affiliation(s)
- Antoine Chapot
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois, Service d'Orthopédie adulte, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland
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Kahhaleh E, Charles T, Collard X, Jayankura M. A low dislocation rate after revision total hip arthroplasty performed through the anterior approach. Arthroplasty 2023; 5:4. [PMID: 36600292 PMCID: PMC9814313 DOI: 10.1186/s42836-022-00159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. METHODS Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. RESULTS At revision surgery, the mean age was 66 ± 12 years (range, 28-91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). CONCLUSION In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. TRIAL REGISTRATION Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.
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Affiliation(s)
- Edward Kahhaleh
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium ,grid.492608.1Department of Orthopaedic Surgery and Traumatology, C.H.U Ambroise Paré, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Tatiana Charles
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Xavier Collard
- grid.492608.1Department of Orthopaedic Surgery and Traumatology, C.H.U Ambroise Paré, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Marc Jayankura
- grid.412157.40000 0000 8571 829XDepartment of Orthopaedic Surgery and Traumatology, C.U.B Erasme, Route de Lennik 808, 1070 Brussels, Belgium
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Lin CC, Yang CC, Yu TC. Comparison of Mid-term Survivorship and Clinical Outcomes between Bipolar Hemiarthroplasty and Total Hip Arthroplasty with Cementless Stem: A Multicenter Retrospective Study. Orthop Surg 2019; 11:221-228. [PMID: 30977594 PMCID: PMC6594502 DOI: 10.1111/os.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare the clinical outcome between bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) using a U2 HA cementless hip stem, and the results of elderly femoral neck fracture patients who underwent BHA with a cementless hip stem. Methods A multicenter retrospective study enrolled 96 BHA and 115 THA cases using U2 HA cementless hip stems with mean age (BHA: 67.9 years; THA: 64.1 years), body height (BHA: 160.4 cm; THA: 160.7 cm) and weight (BHA: 62.7 kg; THA: 64.5 kg) recorded. Mean follow‐up durations were, respectively, 7.1 (BHA) and 7.8 (THA) years. Survivorship analyses and Oxford hip scores were compared. Results Both the BHA and the THA groups revealed high survival rates at 5‐year (100%) and 10‐year (100.0% and 90.1%) follow‐up. The THA group achieved better joint performance and pain relief. The cementless HA stems had survived perfectly for 10 years for elderly femoral neck fracture patients following BHA. Conclusions The U2 HA cementless hip stem provides an effective solution for both BHA and THA surgeries, and for elderly femoral neck fracture patients undergoing BHA. According to the findings of the current study, THA may be inadequate for addressing avascular necrosis, and pain control is a considerable concern for patients who have undergone BHA.
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Affiliation(s)
- Chen-Chiang Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital (Yulin Branch), Yulin, Taiwan
| | - Chang-Chen Yang
- Department of Orthopaedic Surgery, Tzu-Chi Hospital Dalin Branch, Chiayi, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopaedic Surgery, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan
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Lovelock T, O'Brien M, Young I, Broughton N. Two and a half years on: data and experiences establishing a 'Virtual Clinic' for joint replacement follow up. ANZ J Surg 2018; 88:707-712. [PMID: 29952097 DOI: 10.1111/ans.14752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/29/2018] [Accepted: 05/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND We use a 'Virtual Clinic' for follow up of hip and knee replacement patients. The aim of this study was to investigate patient compliance, pain and function, revision rates and surgeon experience using this system. METHODS All hip and knee replacements conducted from 2000 onwards were suitable for 'Virtual Clinic' review. Between July 2014 and December 2016, all patients due for follow up (at 1, 5 and 7 years post-operatively, or biennially thereafter) were mailed an Oxford Hip or Knee Score and a request for a radiograph. A surgeon reviewed the questionnaire and radiograph and decided whether face-to-face review was necessary. We calculated compliance as the percentage of eligible patients who completed the 'Virtual Clinic'. We used retrospective review of medical records for all clinic participants to analyse Oxford scores, disposition following appointment, and revision rates. We reviewed all clinic participants in December 2017 to identify any further revisions. Surgeon feedback was assessed by emailed survey. RESULTS A total of 2076 patients were due for follow up. 1405 patients were contactable, and 710 completed the process. We calculated a 36% compliance rate. Surgeons decided 162 (23%) patients with a mean Oxford score of 24.2 required face-to-face assessment. This identified 13 patients needing revision. One other patient was revised for loosening which developed between 'Virtual Clinic' appointments. Surgeon feedback indicated the inclusion of a 'comment' section on the questionnaire as particularly useful. DISCUSSION We describe our adoption of a 'Virtual Clinic' for joint replacement follow up. We recommend this system as a practical method of following up patients.
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Affiliation(s)
- Thomas Lovelock
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael O'Brien
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Ian Young
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Maritime Operational Health Unit, Royal Australian Navy, Melbourne, Victoria, Australia
| | - Nigel Broughton
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Umar M, Jahangir N, Malik Q, Kershaw S, Barnes K, Morapudi S. Long-term results of metal on metal total hip arthroplasty in younger patients (<55yrs). J Orthop 2018; 15:586-90. [PMID: 29881199 DOI: 10.1016/j.jor.2018.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/06/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction Metal on Metal (MoM) hip arthroplasty saw a new era of popularity with development of its second generation bearing surfaces, in the first decade of this century. However, by the end of that decade, concerns had been raised due to metal debris related complications.We aimed to determine the survival of MoM stemmed hip replacement in younger population. We also studied the rate of revision related to adverse reaction to metal debris (ARMD) along with reviewing the clinical and radiological progress of MoM hip arthroplasty in younger age (<55 yrs) group. Patients & Methods This is a retrospective cohort study of patients 55 yrs old or younger, who had metal on metal (MoM) hip arthroplasty for osteoarthritis. We had 109 procedures performed on 90 patients with a mean follow up of 10 years. All patients were reviewed as per MHRA guidelines in planned follow-up clinics. Data analyses were performed using SPSS. Results Survival of implant in our younger cohort was 88.1% at a mean age if 10 years, with revision for any cause as an endpoint. Most of the patients were happy with the outcome of their hip replacement as they were able to perform activities of daily living and work without compromise. Mean Oxford hip score was 43.Altogether, there were 12 revisions, 7 of these were for metallosis and associated symptoms. Average time to revision was 7 years. Other analysis revealed mean acetabular cup inclination angle to be 49 degrees but no significant correlation was found between this angle and serum metal ion levels. Serum Chromium and Cobalt levels were significantly higher in revision group. Discussion Metal on metal hip arthroplasty prime popularity time has gone. In younger population, although revision rates are higher, the surviving implants give a very good outcome in terms of patient satisfaction. Most of the patients report a desired outcome of 'forgotten hip'.
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Prodinger B, Taylor P. Improving quality of care through patient-reported outcome measures (PROMs): expert interviews using the NHS PROMs Programme and the Swedish quality registers for knee and hip arthroplasty as examples. BMC Health Serv Res 2018; 18:87. [PMID: 29415714 PMCID: PMC5803859 DOI: 10.1186/s12913-018-2898-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system. METHODS First, a systematic search and review was conducted to outline previously identified factors relevant to the integration of PROMs in the selected HIS. A social network analysis was performed to identify networks of experts in these systems. Second, expert interviews were conducted to discuss and elaborate on the identified factors. Directive content analysis was applied using a HIS Evaluation Framework as the frame of reference. This framework is structured into four components: Organization, Human, Technology, and Net benefits. RESULTS The literature review revealed 37 papers for the NHS PROMs Programme and 26 papers for the SHPR and SKAR: Five networks of researchers were identified for the NHS PROMs Programme and 1 for the SHPR and SKAR. Seven experts related to the NHS PROMs Programme and 3 experts related to the SKAR and SHPR participated in the study. The main themes which revealed in relation to Organization were Governance and Capacity building; to Human: Reporting and Stakeholder Engagement; to Technology: the Selection and Collection of PROMs and Data linkage. In relation to Net benefits, system-specific considerations are presented. CONCLUSION Both examples succeeded in integrating PROMs into HIS on a national scale. The lack of an established standard on what change PROMs should be achieved by an intervention limits their usefulness for monitoring quality of care. Whether the PROMs data collected within these systems can be used in routine clinical practice is considered a challenge in both countries.
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Affiliation(s)
- Birgit Prodinger
- University of Applied Sciences Rosenheim, Faculty for Applied Health and Social Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Paul Taylor
- CHIME, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA UK
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Haragus H, Prejbeanu R, Poenaru DV, Deleanu B, Timar B, Vermesan D. Cross-cultural adaptation and validation of a patient-reported hip outcome score. Int Orthop 2018; 42:1001-6. [PMID: 29307032 DOI: 10.1007/s00264-017-3742-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to perform psychometric testing for the translated Oxford Hip Score (OHS) for use as a recommended tool to measure treatment outcomes. METHODS The original English questionnaire was translated and culturally validated using the instrument developer's guidelines and the ISPOR principles of good practice. One hundred patients completed the form together with the Harris Hip Score (HHS) and EQ-5D-5 L. Fifty patients repeated the form after two days. They were suffering from hip osteoarthritis, had had hip replacement or underwent osteosynthesis for a fracture of the trochanteric region. RESULTS The questionnaire had a high degree of reliability with a Cronbach α of 0.917 at the initial completion and 0.917 at the second testing, respectively. The two results were strongly positive and significantly correlated (Pearson's r = 0.947; p < 0.001). The OHS was strongly and significantly correlated with the HHS (Pearson's r = 0.880 initial and r = 0.840 s; p < 0.001) and strongly, positive and significantly correlated with the EQ-5D-5 L VAS (Pearson's r = 0.614 initial and r = 0.704 s; p < 0.001). CONCLUSIONS Our study showed that the translation of the OHS is a reliable, reproducible and valid measure of function in patients who undergo treatment for hip pathology.
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Loth FL, Giesinger JM, Giesinger K, MacDonald DJ, Simpson AHRW, Howie CR, Hamilton DF. Impact of Comorbidities on Outcome After Total Hip Arthroplasty. J Arthroplasty 2017; 32:2755-2761. [PMID: 28506675 DOI: 10.1016/j.arth.2017.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient-reported outcome scores gain increasing importance in quantifying clinical success and procedure remuneration. Our aim was to evaluate the impact of comorbidity on joint-specific outcome and general health in patients undergoing elective total hip arthroplasty (THA). METHODS Longitudinal data on THA procedures were used to evaluate the association between comorbidity and surgical outcome in terms of joint-specific measures and general health (Forgotten Joint Score-12 [FJS-12], Oxford Hip Score [OHS], and Short Form-12) at 1-year follow-up. Comorbidities comprised the Charlson comorbidity index (CCI), low back pain (LBP), pain from other joints (POJ), and body mass index. RESULTS We analyzed data from 251 THA patients (age: 67.7 ± 11.8 years; 58.2% female). Most common conditions were POJ (75.9%), LBP (55.1%), connective tissue disease (12.1%), and diabetes (5.6%). With regard to postoperative improvement, we did not find statistically significant differences between patients with or without CCI comorbidities (FJS-12, +38.7 vs +43.2, P = .370; OHS, +15.6 vs +17.9, P = .100) or POJ (FJS-12, +39.9 vs +45.1, P = .325; OHS, +17.3 vs +16.6, P = .645). Patients with LBP showed less improvement on the FJS-12 than those without LBP (+35.6 vs +49.1; P = .002), whereas no difference was found for the OHS (+17.9 vs +16.5; P = .266). CONCLUSION Patients with comorbid conditions report lower preoperative and postoperative outcome scores compared with patients with no such conditions; however, there was no statistically significant association of CCI comorbidities and POJ with postoperative improvement in joint-specific outcomes. LBP was found to have a negative impact on postoperative improvement in terms of joint awareness.
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Affiliation(s)
- Fanny L Loth
- Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Johannes M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - Karlmeinrad Giesinger
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Deborah J MacDonald
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - A Hamish R W Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin R Howie
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
| | - David F Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, United Kingdom
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Kubo Y, Yamamoto T, Motomura G, Karasuyama K, Sonoda K, Iwamoto Y. Patient-reported outcomes of femoral osteotomy and total hip arthroplasty for osteonecrosis of the femoral head: a prospective case series study. Springerplus 2016; 5:1880. [PMID: 27833839 PMCID: PMC5081314 DOI: 10.1186/s40064-016-3576-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
Background Patient-reported scoring systems have recently been used after surgical procedures. The purpose of this prospective study was to evaluate the patient-reported outcomes of femoral osteotomy and total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). Methods Forty-two symptomatic ONFH patients with asymptomatic contralateral hip underwent either transtrochanteric anterior rotational osteotomy (ARO) or THA as a primary operation. Of these, 20 patients whose contralateral hips remained asymptomatic at the final follow-up (more than 1 year postoperatively) were recruited to participate in this study. Nine patients were treated with ARO (ARO group) and 11 patients were treated with THA (THA group). Both the Oxford hip score (OHS) and the short form 36 (SF-36) were evaluated preoperatively and at the final follow-up. Results The preoperative OHS was 29.1 ± 10.9 and 21.9 ± 9.6 points in the ARO and THA groups, which significantly improved to 38.4 ± 9.4 and 40.3 ± 5.1 points at the final follow-up, respectively. The preoperative physical component summary score was 30.8 ± 12.8 and 17.8 ± 14.5 points in the ARO group and THA groups, which significantly improved to 44.5 ± 10.6 and 43.3 ± 10.4 points at the final follow-up, respectively. The preoperative mental component summary score was 48.0 ± 8.5 and 48.6 ± 11.3 points in the ARO and THA groups, both of which remained unchanged at the final follow-up. Conclusions The short-term patient-reported outcomes of this study suggested that both ARO and THA for ONFH resulted in significantly improved postoperative hip joint function.
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Affiliation(s)
- Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kazuyuki Karasuyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokuraminami-ku, Kitakyushu, 800-0296 Japan
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Benson T, Williams DH, Potts HWW. Performance of EQ-5D, howRu and Oxford hip & knee scores in assessing the outcome of hip and knee replacements. BMC Health Serv Res 2016; 16:512. [PMID: 27659761 PMCID: PMC5034510 DOI: 10.1186/s12913-016-1759-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to compare the performance of EQ-5D-3 L and howRu, which are short generic patient-reported outcome measures (PROMs), in assessing the outcome of hip and knee replacements, using the Oxford Hip Score (OHS) and the Oxford Knee Scores (OKS) for comparison. METHODS Outcome was assessed as the difference between pre-surgery and 6-month post-surgery scores. We used a large sample from the NHS PROMs database, which used EQ-5D-3 L, and a small cohort of patients having the same operations collected by MyClinicalOutcomes (MCO), which used howRu. Both cohorts completed the OHS (hips) or the OKS (knees). RESULTS The change (outcome) between pre-op and post-op scores as measured by howRu was greater than that measured by EQ-5D, relative to that measured by OHS or OKS. For hip replacements, the correlation for change measured by howRu and OHS was r = 0.77 (0.66-0.85). The corresponding correlation for change measured by EQ-5D Index and OHS was r = 0.64 (0.63-0.64). For knee replacements the correlation between change in howRu and OKS was r = 0.86 (0.75-0.92); between EQ-5D Index and OKS r = 0.59 (0.58-0.60). CONCLUSIONS For hip and knee replacement, the outcome measured by howRu was more highly correlated with that measured by the condition-specific Oxford Hip and Knee Scores than were EQ-5D Index or EQ-VAS. The magnitude of change before and after surgery was also greater.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Hermitage, Thatcham, RG18 9WL, UK.,UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK
| | - Dan H Williams
- Royal Cornwall Hospital, Truro, TR1 3LJ, UK.,MyClinicalOutcomes Ltd, London, UK
| | - Henry W W Potts
- UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK.
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Abstract
INTRODUCTION The aim of this study was to assess the independent effect of radiographic measures of implant position, relative to pre-operative anatomical assessment, on the functional outcome of total hip arthroplasty according to change in the Oxford hip score (OHS) 1 year post surgery. METHODS A prospective cohort study was preformed to assess whether improvement in functional outcome (change in OHS at 1 year) and the relationship with femoral offset and length, and acetabular offset and height. After a power calculation 359 patients were recruited to the study and radiographic measures were performed by blinded observers. Regression analysis was used to assess the independent effect of the four radiographic measurements after adjusting for confounding variables. RESULTS There was a significant (p < 0.001) decrease in acetabular offset [5.3 mm, 95 % confidence interval (CI) 4.4-6.2] and increase in femoral offset (6.1 mm, 95 % CI 5.4-6.8). Hence there was no significant change in overall offset. Femoral offset was the only radiographic measure to be achieved statistical significance (r = 0.198, 95 % CI 0.063-0.333, p = 0.004) in relation to clinical outcome, with increasing offset being associated with a greater improvement in the OHS. On combining femoral and acetabular offset increasing offset was associated with a greater improvement in the OHS (r = 0.10, 95 % CI 0.01-0.19, p = 0.04). CONCLUSION This study supports the long-held biomechanical theory of medialisation of the acetabular component with compensatory increased femoral offset results in improved functional outcome.
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Affiliation(s)
- N. D. Clement
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | | | - D. MacDonald
- University of Edinburgh, Little France, Edinburgh, EH16 4SB UK
| | - S. J. Breusch
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
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Naylor JM, Kamalasena G, Hayen A, Harris IA, Adie S. Can the Oxford Scores be used to monitor symptomatic progression of patients awaiting knee or hip arthroplasty? J Arthroplasty 2013; 28:1454-8. [PMID: 23575210 DOI: 10.1016/j.arth.2013.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 02/01/2023] Open
Abstract
We report the week-to-week variation of the Oxford Knee and Oxford Hip Score (OKS, OHS) in individuals with severe osteoarthritis. People waitlisted for knee (n=51) or hip arthroplasty (n=52) were assessed twice, 1-week apart. There were no major week-to-week systematic biases in the scores. Limits of agreement (LOA) for both scores were wide (OKS, -9.5 to 6.6; OHS, -7.7 to 7). For most individual questions, the answers varied by ≤ 1 point in over 90% of participants. The week-to-week 95% LOA for the Oxford scores are unacceptably large, but variations within the individual questions are minimal. Consequently, reference to variation in the individual questions may be more useful for monitoring a patient's preoperative clinical change than changes in the total Oxford score. We conclude that the total scores are not suitable for monitoring the progression of OA in individual patients.
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Affiliation(s)
- Justine M Naylor
- SWS Clinical School, The University of NSW; Whitlam Orthopaedic Research Centre, Liverpool Hospital
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Nourbakhsh M, Zarezadeh A, Shemshaki H, Etemadifar MR, Moezi M, Mazoochian F. Translation and cultural adaptation of the oxford hip score for Iranian population. Int J Prev Med 2013; 4:141-5. [PMID: 23543884 PMCID: PMC3604844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/18/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In recent years, outcome assessment related to orthopedic surgeries has increasingly focused on patient-reported questionnaires. The Oxford Hip Score (OHS), self-administered questionnaire, is a reliable, valid, and responsive instrument for assessing hip in patients undergoing Arthroplasty. METHODS The study involved 105 adult Persian-speaking patients admitted for primary Total Hip Arthroplasty in two hospitals in Isfahan in Iran from September 2009 until April 2011. All of them filled out their scales (Persian OHS, WOMAC, and SF12) in preoperative examination. RESULTS Mean scores of OHS in first administrations was 42.7 ± 12.7. The Persian OHS overall score demonstrated high reproducibility (ICC,0.93, P < 0.001) and internal consistency (CA, 0.94). PersianOHS had high correlations with WOMAC total score (r = 0.86), function score (r = 0.86), and pain score (r = 0.79), the relationship between the Persian OHS and the WOMAC stiffness subscale was somewhat lower (r = 0.69). The correlation coefficient between the Persian OHS and the PCS of the SF-12 in our study was moderate (r = 0.58). Persian OHS had low correlation with MCS of the SF-12 (r = 0.40). DISCUSSION Persian OHS had high correlations with WOMAC total score, function score, and pain score. It had moderate correlation with PCS of the SF-12 and low correlation with MCS of the SF-12. CONCLUSIONS Our study demonstrated the trans-cultural adaptation and validation of the Persian OHS is a reliable and practicable instrument for assessment of function and pain in Iranian patients with hip osteoarthritis.
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Affiliation(s)
- Mohsen Nourbakhsh
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abolghasem Zarezadeh
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shemshaki
- Neuroscience Research Center, Kerman University of Medical Sciences, Jahad Blv, Kerman, Iran
| | - Mohammad R Etemadifar
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Dr. Mohammad Reza Etemadifar, Departments of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Mehdi Moezi
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Paulsen A, Odgaard A, Overgaard S. Translation, cross-cultural adaptation and validation of the Danish version of the Oxford hip score: Assessed against generic and disease-specific questionnaires. Bone Joint Res 2012; 1:225-33. [PMID: 23610695 PMCID: PMC3626210 DOI: 10.1302/2046-3758.19.2000076] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/30/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The Oxford hip score (OHS) is a 12-item questionnaire designed and developed to assess function and pain from the perspective of patients who are undergoing total hip replacement (THR). The OHS has been shown to be consistent, reliable, valid and sensitive to clinical change following THR. It has been translated into different languages, but no adequately translated, adapted and validated Danish language version exists. METHODS The OHS was translated and cross-culturally adapted into Danish from the original English version, using methods based on best-practice guidelines. The translation was tested for psychometric quality in patients drawn from a cohort from the Danish Hip Arthroplasty Register (DHR). RESULTS The Danish OHS had a response rate of 87.4%, no floor effect and a 19.9% ceiling effect (as expected in post-operative patients). Only 1.2% of patients had too many items missing to calculate a sum score. Construct validity was adequate and 80% of our predefined hypotheses regarding the correlation between scores on the Danish OHS and the other questionnaires were confirmed. The intraclass correlation (ICC) of the different items ranged from 0.80 to 0.95 and the average limits of agreement (LOA) ranged from -0.05 to 0.06. The Danish OHS had a high internal consistency with a Cronbach's alpha of 0.99 and an average inter-item correlation of 0.88. CONCLUSIONS This Danish version of the OHS is a valid and reliable patient-reported outcome measurement instrument (PROM) with similar qualities to the original English language version.
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Affiliation(s)
- A Paulsen
- Odense University Hospital, Department of Orthopaedics and Traumatology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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