Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

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, Martin Krismer, Bernd Stoeckl, Knahr Knahr, Oswald Pinggera, Pekka YlinenMoussa Hammadouche, Christian Delaunay, Philippe Chiron, Sabrina Baumann, Dagmar Groeber-Graetz, 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, Victoria Cavendish, Peter Kellermann, Ildiko Fistzer, Paolo Gallinaro, Alessandro Masse, Andrzej Gorecki, Maciek Ambroziak, Eduardo Garcia-Cimbrelo, Urban Benger, Christian Hellerfelt, Christer Olson, Ivan Broger, Robert Theiler, Kurt Uehlinger, Angela Hett, Til Stuermer

Rannsóknarafurð: Framlag til fræðitímaritsGreinritrýni

88 Tilvitnanir (Scopus)


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.

Upprunalegt tungumálEnska
Númer greinar19
FræðitímaritBMC Musculoskeletal Disorders
ÚtgáfustaðaÚtgefið - 2009


Funding Information:
The European collaborative database of cost and practice patterns of THR (EUROHIP) was supported by the Bertelsmann Foundation and Cen-trepulse Orthopaedic Ltd (Sulzer Medical Ltd). This cohort study was also supported by the Medical Research Council, Health Services Research Collaboration (MRC HSRC). The authors wish to thank the many surgical teams and individuals who contributed to the success of this project. We would also like to thank the EUROHIP advisor committee comprising Hermann Brenner, Maxime Dougados, Klaus Hug and Heiner Raspe.


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