Document Detail

Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres.
MedLine Citation:
PMID:  19208230     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Total 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.
METHODS: A 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.
RESULTS: Data 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.
CONCLUSION: 1. 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.
Paul Dieppe; Andrew Judge; Susan Williams; Ifeoma Ikwueke; Klaus-Peter Guenther; Markus Floeren; Joerg Huber; Thorvaldur Ingvarsson; Ian Learmonth; L Stefan Lohmander; Anna Nilsdotter; Wofhart Puhl; David Rowley; Robert Thieler; Karsten Dreinhoefer;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-02-10
Journal Detail:
Title:  BMC musculoskeletal disorders     Volume:  10     ISSN:  1471-2474     ISO Abbreviation:  BMC Musculoskelet Disord     Publication Date:  2009  
Date Detail:
Created Date:  2009-03-16     Completed Date:  2009-05-19     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  100968565     Medline TA:  BMC Musculoskelet Disord     Country:  England    
Other Details:
Languages:  eng     Pagination:  19     Citation Subset:  IM    
Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford, UK.
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MeSH Terms
Age Factors
Aged, 80 and over
Arthroplasty, Replacement, Hip*
Cohort Studies
Disability Evaluation
Educational Status
Health Status
Middle Aged
Osteoarthritis, Hip / physiopathology*,  radiography,  surgery*
Preoperative Care*
Severity of Illness Index
Sex Factors
Grant Support
//Medical Research Council
Martin Krismer / ; Bernd Stoeckl / ; Karl Knahr / ; Oswald Pinggera / ; Pekka Ylinen / ; Moussa Hammadouche / ; Christian Delaunay / ; Philippe Chiron / ; Wolfhart Puhl / ; Karsten Dreinhoefer / ; Markus Floeren / ; Sabrina Baumann / ; Dagmar Groeber-Graetz / ; Klaus-Peter Guenther / ; Stefan Fickert / ; Joachim Löhr / ; Alexander Katzer / ; Dietrich Klüber / ; Volker Ewerbeck / ; Peter Aldinger / ; Dominik Parsch / ; Wolfram Neumann / ; Ingmar Meinecke / ; Thomas Bittner / ; Wilfried von Eiff / ; Conrad Middendorf / ; Hans-Peter Scharf / ; Peter Schraeder / ; Sabine Schmitt / ; David Rowley / ; Ian Learmonth / ; Paul Dieppe / ; Victoria Cavendish / ; Susan Williams / ; Peter Kellermann / ; Ildiko Fistzer / ; Thorvaldur Ingvarsson / ; Paolo Gallinaro / ; Alessandro Masse / ; Andrzej Gorecki / ; Maciek Ambroziak / ; Eduardo Garcia-Cimbrelo / ; Anna Nilsdotter / ; Urban Benger / ; Christian Hellerfelt / ; Christer Olson / ; Lasarett Karlshamm / ; Joerg Huber / ; Ivan Broger / ; Robert Theiler / ; Kurt Uehlinger / ; Angela Hett / ; Til Stuermer /

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