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

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

doi:10.1186/s12891-017-1455-y

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

BMC Musculoskelet Disord. 2017 Mar 3;18(1):97. doi: 10.1186/s12891-017-1455-y.

Authors

Philip J van der Wees¹, Joost J G Wammes², Reinier P Akkermans^{1

3}, Jan Koetsenruijter¹, Gert P Westert¹, Albert van Kampen⁴, Gerjon Hannink⁴, Maarten de Waal-Malefijt⁴, B Willem Schreurs⁴

Affiliations

¹ Radboud University Medical Center, Radboud Institute for Health Sciences; Scientific Institute for Quality of Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
² Radboud University Medical Center, Radboud Institute for Health Sciences; Scientific Institute for Quality of Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. joost.wammes@radboudumc.nl.
³ Radboud University Medical Center, Radboud Institute for Health Sciences; Primary and Community Care, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
⁴ Department of Orthopedics, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.

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.

Keywords: Outcomes measurement; Patient-reported outcomes; Total hip replacement; Total knee replacement.

Publication types

Comparative Study

MeSH terms

Aged
Arthroplasty, Replacement, Hip / statistics & numerical data*
Arthroplasty, Replacement, Knee / statistics & numerical data*
Feasibility Studies
Female
Hospitals, University / statistics & numerical data*
Humans
Male
Middle Aged
Ontario
Pain Measurement
Patient Reported Outcome Measures*
Quality Improvement*
Quality of Life
Recovery of Function
Registries
Retrospective Studies
Treatment Outcome