Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry

Authors: Philip J. van der Wees, Joost J. G. Wammes, Reinier P. Akkermans, Jan Koetsenruijter, Gert P. Westert, Albert van Kampen, Gerjon Hannink, Maarten de Waal-Malefijt, B. Willem Schreurs

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Login to get access

Abstract

Background

Patient-Reported Outcome (PRO) measurement is a method for measuring perceptions of patients on their health and quality of life. The aim of this paper is to present the results of PRO measurements in total hip and knee replacement as routinely collected during 20 years of surgery in a university hospital setting.

Methods

Data of consecutive patients between 1993 and 2014 were collected. Health outcomes were measured pre-surgery and at 3, 6, and 12 months post-surgery. Outcomes for hip replacement were measured with the Harris Hip Score (HHS) and Oxford Hip Score (OHS). Outcomes for knee replacement were measured with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Society Score (KSS). A Visual Analog Scale (VAS) for pain was used. Absolute and relative Minimal Clinically Important Differences (MCID) were estimated. Generalized estimating equation analysis was used for estimating mean outcomes. Trends over time were analyzed.

Results

The database contained 2,089 patients with hip replacement, and 704 patients with knee replacement. Mean HHS and OHS scores in primary hip replacement at 12 months post-surgery were 86.7 (SD: 14.5) and 41.1 (SD: 7.5) respectively. Improvements on the HHS based on absolute MCID was lower for revisions compared to primary hip replacements, with 72.4% and 87.0% respectively. Mean WOMAC and KSS scores in knee replacement at 12 months post-surgery were 21.5 (SD: 18.2) and 67.0 (SD: 26.4) respectively. Improvements based on absolute MCID were lowest for the KSS (62.6%) and highest for VAS pain (85.6%). Trend analysis showed a difference in 1 out of 24 comparisons in hip replacement and in 2 out of 9 comparisons in knee replacement.

Conclusions

The functional status of a large cohort of patients significantly improved after hip and knee replacement based on routine data collection. Our study shows the feasibility of the routine collection of PRO data in patients with total hip and knee replacement. The use of PRO data provides opportunities for continuous quality improvement.
Literature
1.
Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35.CrossRefPubMedPubMedCentral
2.
3.
Santaguida PL, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51(6):428–36.PubMedPubMedCentral
4.
5.
Kalairajah Y, et al. Health outcome measures in the evaluation of total hip arthroplasties--a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty. 2005;20(8):1037–41.CrossRefPubMed
6.
Arden NK, et al. What is a good patient reported outcome after total hip replacement? Osteoarthritis Cartilage. 2011;19(2):155–62.CrossRefPubMed
7.
Wu AW, et al. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol. 2013;66 Suppl 8:S12–20.CrossRefPubMedPubMedCentral
8.
Van der Wees P. J, et al. Integrating the use of patient-reported outcomes for both clinical practice and for performance measurement: experts’ views from three countries. The Milbank Quarterly [forthcoming]. 2014.
9.
Reuben DB, Tinetti ME. Goal-oriented patient care--an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777–9.CrossRefPubMed
10.
11.
Havelin LI, et al. A Scandinavian experience of register collaboration: the Nordic Arthroplasty Register Association (NARA). J Bone Joint Surg Am. 2011;93 Suppl 3:13–9.CrossRefPubMed
12.
Rothwell AG, et al. 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). 2010;92(3):413–8.CrossRef
13.
NJR. Annual report 2013. National Joint Registry for England, Wales and Northern Ireland. Hertfordshire: National Joint Registry; 2013.
14.
15.
Franklin PD, Harrold L, Ayers DC. Incorporating patient-reported outcomes in total joint arthroplasty registries: challenges and opportunities. Clin Orthop Relat Res. 2013;471(11):3482–8.CrossRefPubMedPubMedCentral
16.
Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res. 2011;63 Suppl 11:S200–7.CrossRef
17.
Murray DW, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg (Br). 2007;89(8):1010–4.CrossRef
18.
Escobar A, et al. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007;15(3):273–80.CrossRefPubMed
19.
20.
Insall JN, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–4.
21.
22.
Hawker GA, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63 Suppl 11:S240–52.CrossRef
23.
de Waal Malefijt MC. An orthopedic complication-registration system. Acta Orthop Scand. 1995;66(1):84–9.CrossRefPubMed
24.
Browne JP, et al. Mathematical coupling may account for the association between baseline severity and minimally important difference values. J Clin Epidemiol. 2010;63(8):865–74.CrossRefPubMed
25.
Revicki D, et al. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61(2):102–9.CrossRefPubMed
26.
Farrar JT, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58.CrossRefPubMed
27.
Ostelo RWJG, et al. Interpreting change scores for pain and functional status in low back pain - Towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4.CrossRefPubMed
28.
Stratford PW, et al. Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part 1. Phys Ther. 1998;78(11):1186–96.CrossRefPubMed
29.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737–55.CrossRefPubMed
30.
Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S200–207.CrossRef
31.
Harris K, et al. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty. Patient Relat Outcome Meas. 2016;7:101–8.CrossRefPubMedPubMedCentral
32.
Angst F, et al. The factor subdimensions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) help to specify hip and knee osteoarthritis. a prospective evaluation and validation study. J Rheumatol. 2005;32(7):1324–30.PubMed
33.
White DK, et al. Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study. J Rheumatol. 2010;37(6):1244–51.CrossRefPubMedPubMedCentral
34.
Tubach F, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005;64(1):29–33.CrossRefPubMed
35.
36.
Asif S, Choon DS. Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg. 2005;13(3):280–4.CrossRef
37.
Hanley JA, et al. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157(4):364–75.CrossRefPubMed
38.
Ng CY, Ballantyne JA, Brenkel IJ. Quality of life and functional outcome after primary total hip replacement. A five-year follow-up. J Bone Joint Surg (Br). 2007;89(7):868–73.CrossRef
39.
Xie F, et al. Evaluation of health outcomes in osteoarthritis patients after total knee replacement: a two-year follow-up. Health Qual Life Outcomes. 2010;8:87.CrossRefPubMedPubMedCentral
40.
41.
Beswick AD, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435.CrossRefPubMedPubMedCentral
42.
Lavernia CJ, Alcerro JC. Quality of life and cost-effectiveness 1 year after total hip arthroplasty. J Arthroplasty. 2011;26(5):705–9.CrossRefPubMed
43.
Singh JA, Lewallen DG. Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes. BMC Musculoskelet Disord. 2014;15:440.CrossRefPubMedPubMedCentral
44.
45.
46.
Gardner LA, et al. Leveraging improvement in quality and value in health care through a clinical performance measure framework: a recommendation of the American College of Physicians. Am J Med Qual. 2010;25(5):336–42.CrossRefPubMed
47.
Cella D, et al. Methodological issues in the selection, administration and use of patient-reported outcomes in perfomance meaasurement in health care settings, ed. N.Q.F. (NQF), Washingtdon, DC: National Quality Forum (NQF); 2012.
48.
Rana AJ. Building a Patient-Reported Outcome Metric Database: One Hospital's Experience. J Arthroplasty. 2016;31(6):1151–4.CrossRefPubMed
49.
LROI, Insight into Quality & Safety. Annual Report of the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten) 2013, 2013, LROI: 's Hertogenbosch.
Metadata
Title
Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry
Authors
Philip J. van der Wees
Joost J. G. Wammes
Reinier P. Akkermans
Jan Koetsenruijter
Gert P. Westert
Albert van Kampen
Gerjon Hannink
Maarten de Waal-Malefijt
B. Willem Schreurs
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1455-y

Other articles of this Issue 1/2017

BMC Musculoskeletal Disorders 1/2017 Go to the issue

Research article

The effect of low intensity shockwave treatment (Li-SWT) on human myoblasts and mouse skeletal muscle

Research article

Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures – postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

Case report

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

Study protocol

A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol

Research article

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

Research article

Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients