Moderate strength evidence supports that the practitioner could use risk assessment tools to assist in predicting adverse events, assessing surgical risks and educating patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.

Rationale

One high quality study (Gordon, Frumento, et al) employed the Charnley comorbidity classification and the EQ5D generic health outcome questionnaire in the Swedish Hip Registry of over 28,500 THA patients.  Inferior THA results were demonstrated in a specific subset of patients:  women with  Charnley class C.  Five moderate quality and five low quality studies further support the use of various risk assessment tools to predict outcomes and adverse events after THA.  These include the EQ5D, SF-36, WOMAC, ASA classification, Charlson comorbidity index, and the Elixhauser score.  Rolfson and Dahlberg, et al analyzed 6,158 Swedish Registry patients  to determine that the EQ-5D  anxiety/depression domain was highly predictive for pain relief and patient satisfaction after THA.  Using the WOMAC and SF-36 Short Form, Gandhi, et al demonstrated that older age, year of followup, and greater comorbidity were negative prognostic indicators for THA function, and proposed that risk assessment data may be effectively utilized to set realistic patient expectations after THA.  In another moderate quality study, Gordon and Frumento, et al studied over 134,000 patients from the Swedish registry.  The Elixhauser comorbidity score was directly related to risk of re-operation within two years after THA.  Martinez-Huedo, et al examined the effect of  diabetes mellitus (DM) on 122,926 THA patients in the Spanish National Hospital Database.  Immediate postoperative outcomes were worse among patients with DM, including increased length of hospital stay and in-hospital mortality.  With respect to patients’ preoperative expectations, Judge, et al investigated the use of  ASA status, WOMAC score, and EQ-5D, to show that risk assessment tools can be effectively utilized for informed patient-clinician decision-making.

  1. Gordon, M.; Frumento,P.; Skoldenberg,O.; Greene,M.; Garellick,G.; Rolfson,O. Women in Charnley class C fail to improve in mobility to a higher degree after total hip replacement. Acta Orthop; 2014/8: 4
  2. Rolfson,O.; Dahlberg,L.E.; Nilsson,J.A.; Malchau,H.; Garellick,G. Variables determining outcome in total hip replacement surgery. J Bone Joint Surg Br; 2009/2: 2
  3. Gordon, M.; Paulsen,A.; Overgaard,S.; Garellick,G.; Pedersen,A.B.; Rolfson,O. Factors influencing health-related quality of life after total hip replacement - A comparison of data from the Swedish and Danish hip arthroplasty registers. BMC Musculoskeletal Disorders; 2013: 0
  4. Martinez-Huedo,M.A.; Villanueva,M.; de Andres,A.L.; Hernandez-Barrera,V.; Carrasco-Garrido,P.; Gil,A.; Martinez,D.; Jimenez-Garcia,R. Trends 2001 to 2008 in incidence and immediate postoperative outcomes for major joint replacement among Spanish adults suffering diabetes. Eur J Orthop Surg Traumatol.; 2013/1: 1
  5. Judge,A.; Cooper,C.; Arden,N.K.; Williams,S.; Hobbs,N.; Dixon,D.; Gunther,K.P.; Dreinhoefer,K.; Dieppe,P.A. Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis Cartilage; 2011/6: 6