Abstract
A scoring system that objectively weighs up the indications, contra-indications and order of priority for joint replacement is useful when assessing patients who demand surgery or when providing health fund providers with objective motivation for surgery.
The appropriate American score (Harris Hip Score or American Knee Society Rating) is applied. The scoring system goes on to assess the degree of pain and functional ability in greater depth. It takes into consideration the extent of other affected joints and the ability to perform normal activities of daily living such as driving, dressing, foot care, bathing and recreational pursuits.
The functional demands of the patient’s activities at home are then assessed, taking into account how much assistance is available, and what need there is to shop or make use of public transport, and how much walking or stair-climbing this entails. To this is added an assessment of the functional demands or stresses of the patient’s occupation. By adding the American scores and the additional scores for pain and functional ability, and subtracting from that total the score for functional demands at home and at work, one arrives at a score for the degree of compromise (American Score + pain + function – functional demand = compromise score). A lower score means greater compromise.
Finally, one determines the risk of morbidity and mortality. The greater the risk, the lower the compromise score should be. The contra-indication score is reached by multiplying the compromise score by the morbidity and mortality risks and dividing by 100. Depending on how one looks at it, the contra-indication score reflects either the urgency of surgery or the degree of resistance against it.
The abstracts were prepared by Professor M.B.E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
