THE VALUE OF PATIENT REPORTED OUTCOMES IN LONG TERM HIP SURVEILLANCE

Abstract

Introduction: The BOA recommends clinical and radiological arthroplasty follow up at one year then every five years. Increasing pressures placed on NHS Trusts with the implementation of the 18 week pathway and limitation on new:follow-up ratios has increased the use of patient reported outcome scores in arthroplasty follow-up. No single score is validated for this purpose, and there is no data surrounding their effectiveness as a screening tool for aseptic loosening.

Patients & Results: Patients undergoing their 10 year follow were included in the study and scored with the Harris (HHS), Hospital for Special Surgery (HSS), Merle d’Aubigne (MDA), Visual Analogue (VAS) or Oxford Hip Score (OHS) according to the unit’s established follow-up protocol. All patients underwent clinical and radiographic review in addition to scoring. Patients subsequently listed for revision surgery were defined as failure. Statistical analysis included significance testing and ROC analysis to determine the predictive value of the individual scores.

Four hundred and twelve patients were included in the study. The mean Harris, VAS and HSS were significantly different between the failed and well fixed groups. However there was no statistically significant difference between the mean Oxford and MDA scores. ROC analysis demonstrated the Harris (0.97), VAS (0.98) and HSS (0.77) score to have good prediction of outcome.

Discussion: The scores in our study have been validated as outcome measures for joint arthroplasty, however they perform differently in the follow-up setting. There is evidence that a failing hip is reflected in a poorer VAS, Harris, Oxford and HSS scores however the VAS was more sensitive and specific than any hip score. Patient administered outcomes have a place in the follow up of joint replacement it must be remembered they are validated as outcome measures, not for follow up purposes.