Top

International Orthopaedics

Published in:

Open Access 01-02-2018 | Original Paper

Can patient-reported outcomes predict re-operations after total hip replacement?

Authors: Ted Eneqvist, Szilárd Nemes, Erik Bülow, Maziar Mohaddes, Ola Rolfson

Published in: International Orthopaedics | Issue 2/2018

Abstract

Purpose

We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register.

Methods

A total of 75,899 patients with THR due to osteoarthritis operated in 2002–2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C).

Results

Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3–95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power.

Conclusions

Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.

Garellick G, Karrholm J, Lindahl H, Malchau H, Rogmark C, Rolfson O (2015) Swedish hip arthroplasty register annual report 2014. Göran Garellick, Gothenburg, Sweden

Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Ivar Havelin L, Furnes O, Marie Fenstad A, Pedersen AB, Overgaard S, Karrholm J, Garellick G, Malchau H, Makela KT (2016) Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty register association database. Acta Orthop 87:546–553. https://doi.org/10.1080/17453674.2016.1222804 CrossRefPubMedPubMedCentral

Kärrholm J, Lindahl H, Malchau H, Mohaddes M, Rogmark C, Rolfson O (2016) Swedish hip arthroplasty register. Annual Report 2015. Ola Rolfson, Gothenburg, Sweden

Espehaug B, Havelin LI, Engesaeter LB, Langeland N, Vollset SE (1998) Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop Relat Res 351:135-48

Lie SA, Vollset LI, Havelin ON, Furnes LB, Engesæster SE (2004) Failure rates for 4762 revision total hip arthroplasties in the Norwegian arthroplasty register. J Bone Joint Surg B 86:504–509. https://doi.org/10.1302/0301-620X.86B4.14799

Lübbeke A, Katz JN, Perneger TV, Hoffmeyer P (2007) Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol 34:394PubMed

Adelani MA, Crook K, Barrack RL, Maloney WJ, Clohisy JC (2014) What is the prognosis of revision total hip arthroplasty in patients 55 years and younger? Clin Orthop Relat Res 472:1518–1525. https://doi.org/10.1007/s11999-013-3377-9 CrossRefPubMed

Bolz KMD, Crawford RW, Donnelly B, Whitehouse SL, Graves N (2010) The cost-effectiveness of routine follow-up after primary total hip arthroplasty. J Arthroplast 25:191–196. https://doi.org/10.1016/j.arth.2008.12.009 CrossRef

Sethuraman V, McGuigan J, Hozack WJ, Sharkey PF, Rothman RH (2000) Routine follow-up office visits after total joint replacement: do asymptomatic patients wish to comply? J Arthroplast 15:183–186. https://doi.org/10.1016/S0883-5403(00)90176-1 CrossRef

10.

Dy CJ, Bozic KJ, Pan TJ, Wright TM, Padgett DE, Lyman S (2014) Risk factors for early revision after total hip arthroplasty. Arthritis Care Res 66:907–915. https://doi.org/10.1002/acr.22240 CrossRef

11.

Paxton EW, Inacio MCS, Khatod M, Yue E, Funahashi T, Barber T (2015) Risk calculators predict failures of knee and hip arthroplasties: findings from a large health maintenance organization. Clin Orthop Relat Res 473:3965. https://doi.org/10.1007/s11999-015-4506-4 CrossRefPubMedPubMedCentral

12.

Wright EA, Katz JN, Baron JA, Wright RJ, Malchau H, Mahomed N, Prokopetz JJZ, Losina E (2012) Risk factors for revision of primary total hip replacement: results from a national case–control study. Arthritis Care Res 64:1879–1885. https://doi.org/10.1002/acr.21760 CrossRef

13.

Prokopetz JJZ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN (2012) Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 13:251–251. https://doi.org/10.1186/1471-2474-13-251 CrossRefPubMedPubMedCentral

14.

Singh JA, Schleck C, Harmsen S, Lewallen D (2016) Clinically important improvement thresholds for Harris hip score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord 17:256. https://doi.org/10.1186/s12891-016-1106-8 CrossRefPubMedPubMedCentral

15.

Rothwell AG, Hooper GJ, Hobbs A, Frampton CM (2010) An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand joint registry. J Bone Joint Surg Br 92:413–418. https://doi.org/10.1302/0301-620x.92b3.22913 CrossRefPubMed

16.

Devane P, Horne G, Gehling D (2013) Oxford hip scores at 6 months and 5 years are associated with total hip revision within the subsequent 2 years. Clin Orthop Relat Res 471:3870–3874. https://doi.org/10.1007/s11999-013-2880-3 CrossRefPubMedPubMedCentral

17.

Greene ME, Rolfson O, Gordon M, Garellick G, Nemes S (2015) Standard comorbidity measures do not predict patient-reported outcomes 1 year after total hip arthroplasty. Clin Orthop Relat Res 473:1–10

18.

Rolfson O, Karrholm J, Dahlberg LE, Garellick G (2011) Patient-reported outcomes in the Swedish hip arthroplasty register: results of a nationwide prospective observational study. J Bone Joint Surg Br 93:867–875. https://doi.org/10.1302/0301-620x.93b7.25737 CrossRefPubMed

19.

Greene ME, Rolfson O, Garellick G, Gordon M, Nemes S (2015) Improved statistical analysis of pre- and post-treatment patient-reported outcome measures (PROMs): the applicability of piecewise linear regression splines. Qual Life Res 24:567–573. https://doi.org/10.1007/s11136-014-0808-3 CrossRefPubMed

20.

EuroQol Group (1990) EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208

21.

Scott J, Huskisson E (1976) Graphic representation of pain. Pain 2:175–184CrossRefPubMed

22.

Devlin NJ, Krabbe PFM (2013) The development of new research methods for the valuation of EQ-5D-5L. Eur J Health Econ 14(Suppl 1):S1–3

23.

Heagerty PJ, Zheng Y (2005) Survival model predictive accuracy and ROC curves. Biometrics 61:92–105. https://doi.org/10.1111/j.0006-341X.2005.030814.x CrossRefPubMed

24.

Shmueli G (2010) To explain or to predict? Stat Sci 25:289–310. https://doi.org/10.1214/10-STS330 CrossRef

25.

Pepe MS, Longton G, Leisenring W, Newcomb P, Janes H (2004) Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 159:882–890. https://doi.org/10.1093/aje/kwh101 CrossRefPubMed

Title: Can patient-reported outcomes predict re-operations after total hip replacement?
Authors: Ted Eneqvist
Szilárd Nemes
Erik Bülow
Maziar Mohaddes
Ola Rolfson
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3711-z

At a glance: The STEP trials

Springer Medicine

Can patient-reported outcomes predict re-operations after total hip replacement?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Knee function after limb salvage surgery for malignant bone tumor: comparison of megaprosthesis and distal femur allograft with epiphysis sparing

High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem

Prolonged hospital stay before hip fracture surgery in the elderly: a single parameter but multiple roles

Letter to the editor on “Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series” by Hwang et al.

Redefining anterior shoulder impingement: a literature review

Treatment of hip fracture of Pope Innocent XII by Marcello Malpighi with bed rest