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Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres

Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres
Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres
Objective

Patients’ expectations of surgery may be related to outcomes of joint replacement. The aims of this study were to: (1). Identify patient characteristics associated with pre-operative expectations of total hip replacement (THR); (2). Explore whether pre-operative expectations predict surgical outcomes 12-months post-THR.
Method

The European collaborative database of cost and practice patterns of THR (EUROHIP) study consists of 1327 consenting patients coming to primary THR for osteoarthritis (OA) across 20 European orthopaedic centres. Ordered logistic regression modelling was used to look at the association between patients pre-operative expectations and baseline characteristics (age, sex, education, American Society of Anaesthesiologists (ASA) status, Kellgren & Lawrence (K&L) grade, body mass index (BMI), medication use, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, EQ5D (EuroQol) score). The Outcome Measures in Rheumatology (OMERACT)/Osteoarthritis Research Society International (OARSI) responder criteria were used to classify patients as improved/not improved 12-months post-THR. Logistic regression modelling was used to explore whether pre-operative expectations predict response to THR.
Results

Greater numbers of pre-operative expectations were associated with younger age, women, increasing BMI, and more education. The more pre-operative expectations a patient had, the more likely they were to improve after surgery. Each individual expectation a patient had, was associated with a 34% increase in improvement [95% confidential interval (CI) 1%–78%]. Analyses within dimensions of the WOMAC suggest the association is strongest for stiffness and function.
Conclusion

There is large variation in patients’ pre-operative expectations of THR. Greater numbers of pre-operative expectations were associated with improvement following THR. This appears to be driven more by stiffness and function. These findings have implications for informed patient–clinician decision-making.
1063-4584
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Williams, S.
762dd529-2acb-40b8-acf3-e3488eec8506
Hobbs, N.
f6e1dc7a-fd94-418d-bfe5-972cd88e0a45
Dixon, D.
7d5fc55d-89e5-4964-95e2-3bbb79d354ad
Gunther, K.P.
f2a76baf-1da0-4391-a5a4-957f9952b784
Dreinhoefer, K.
1bc6b5f2-a2ba-47b5-b5c4-ef8499aa588f
Dieppe, P.A.
74be978d-206a-4ed7-8da9-6d0cb5fa8a9e
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Williams, S.
762dd529-2acb-40b8-acf3-e3488eec8506
Hobbs, N.
f6e1dc7a-fd94-418d-bfe5-972cd88e0a45
Dixon, D.
7d5fc55d-89e5-4964-95e2-3bbb79d354ad
Gunther, K.P.
f2a76baf-1da0-4391-a5a4-957f9952b784
Dreinhoefer, K.
1bc6b5f2-a2ba-47b5-b5c4-ef8499aa588f
Dieppe, P.A.
74be978d-206a-4ed7-8da9-6d0cb5fa8a9e

Judge, A., Cooper, C., Arden, N.K., Williams, S., Hobbs, N., Dixon, D., Gunther, K.P., Dreinhoefer, K. and Dieppe, P.A. (2011) Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis and Cartilage. (doi:10.1016/j.joca.2011.03.009).

Record type: Article

Abstract

Objective

Patients’ expectations of surgery may be related to outcomes of joint replacement. The aims of this study were to: (1). Identify patient characteristics associated with pre-operative expectations of total hip replacement (THR); (2). Explore whether pre-operative expectations predict surgical outcomes 12-months post-THR.
Method

The European collaborative database of cost and practice patterns of THR (EUROHIP) study consists of 1327 consenting patients coming to primary THR for osteoarthritis (OA) across 20 European orthopaedic centres. Ordered logistic regression modelling was used to look at the association between patients pre-operative expectations and baseline characteristics (age, sex, education, American Society of Anaesthesiologists (ASA) status, Kellgren & Lawrence (K&L) grade, body mass index (BMI), medication use, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, EQ5D (EuroQol) score). The Outcome Measures in Rheumatology (OMERACT)/Osteoarthritis Research Society International (OARSI) responder criteria were used to classify patients as improved/not improved 12-months post-THR. Logistic regression modelling was used to explore whether pre-operative expectations predict response to THR.
Results

Greater numbers of pre-operative expectations were associated with younger age, women, increasing BMI, and more education. The more pre-operative expectations a patient had, the more likely they were to improve after surgery. Each individual expectation a patient had, was associated with a 34% increase in improvement [95% confidential interval (CI) 1%–78%]. Analyses within dimensions of the WOMAC suggest the association is strongest for stiffness and function.
Conclusion

There is large variation in patients’ pre-operative expectations of THR. Greater numbers of pre-operative expectations were associated with improvement following THR. This appears to be driven more by stiffness and function. These findings have implications for informed patient–clinician decision-making.

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More information

Published date: 11 April 2011

Identifiers

Local EPrints ID: 183331
URI: http://eprints.soton.ac.uk/id/eprint/183331
ISSN: 1063-4584
PURE UUID: d94dba61-7404-4b8e-aa7c-45b66d931177
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 03 May 2011 11:43
Last modified: 18 Mar 2024 02:45

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Contributors

Author: A. Judge
Author: C. Cooper ORCID iD
Author: N.K. Arden
Author: S. Williams
Author: N. Hobbs
Author: D. Dixon
Author: K.P. Gunther
Author: K. Dreinhoefer
Author: P.A. Dieppe

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