Abstract
Health fund providers often require objective motivation for surgery, and patients often try to pressurise surgeons into operating. The author developed a scoring system to weigh up objectively the indications and contra-indications for and urgency of joint replacement.
A considerably expanded Harris Hip Score and American Knee Society ratings are used. Rather than using a subjective adjective to evaluate pain, it is objectively evaluated by type and frequency of analgesic. The totality of the patient’s condition is considered in assessing functional ability, particularly with regard to other affected joints and the patient’s ability to perform normal activities of daily living. Taken into account is how much walking, climbing and stair-climbing a patient’s work demands and whether getting to work requires a long walk or use of public transport. The functional demands of daily home life are assessed, and also how much assistance is available to the patient.
By adding the American scores to the additional scores for pain and functional ability, and then subtracting that total from the functional demand, one arrives at a score for the degree of compromise. The scoring includes a prediction of the risk of morbidity and mortality. When this risk is balanced by the degree of compromise, one arrives at a score for contra-indication. Put another way, pain + functional ability – functional demand = compromise, and compromise x risk of mortality and morbidity = contraindication.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
