Identification of Potential High-Risk Patients on the Basis of PROMs in a Certified Centre for Joint Replacement (EndoProthetikZentrum) Using the Example of Hip Arthroplasty

Abstract

Background In addition to clinical parameters, the subjective assessment by the patient to evaluate the operative outcome of an arthroplasty is becoming increasingly important. Questionnaires are used to identify patients who have not achieved the treatment goal at an early stage so that further interventions can be indicated.

Material and Methods A questionnaire consisting of different PROMs was completed pre- and 3 months postoperatively by patients who had been treated with a hip arthroplasty. A standardised follow-up examination of these patients was carried out 12 to 16 weeks postoperatively, after which it was determined whether further therapy was necessary to achieve the treatment goal. Different consequences were defined for this.

Results Significant differences were found between the groups of consequences of follow-up examinations over both time points, but also when postoperative scores were considered exclusively. Furthermore, the correlations for the postoperative scores and some consequences of the clinical follow-up for the Oxford Hip Score (OHS), the OHS functional score and the Euroquol-5D show moderate effects. Thus, the collection of these postoperative scores is sufficient to identify potential high risk patients. Based on a receiver operating characteristic (ROC) analysis, threshold values could be determined for these scores, for which a follow-up examination is recommended.

Conclusion Patients who could not achieve functional improvement, pain reduction and improvement in quality of life after implantation of a total hip replacement must be identified at an early stage. The results of our study show that with the help of the Oxford Hip Score and Euroquol-5D, which are answered by the patients three months postoperatively, such high risk patients can be identified. This finding is an added value for the further development of the EndoCert certification system and holistic quality assurance in arthroplasties, while the personnel and time effort remain manageable.

Key words

EndoCert - follow-up study - hip arthroplasty - Oxford Score - Euroquol-5D

Publikationsverlauf

Artikel online veröffentlicht:
19. April 2021

• References/Literatur

• 1 Hamilton DF, Giesinger JM, Giesinger K. It is merely subjective opinion that patient-reported outcome measures are not objective tools. Bone Joint Res 2017; 6: 665-666 doi:10.1302/2046-3758.612.BJR-2017-0347
• 2 Ethgen O, Bruyère O, Richy F. et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86: 963-974 doi:10.2106/00004623-200405000-00012
• 3 Kjærgaard N, Kjærsgaard JB, Petersen CL. et al. Thresholds for the Oxford Hip Score after total hip replacement surgery: a novel approach to postoperative evaluation. J Orthop Traumatol 2017; 18: 401-406 doi:10.1007/s10195-017-0465-8
• 4 Rothwell AG, Hooper GJ, Hobbs A. et al. An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br 2010; 92: 413-418 doi:10.1302/0301-620X.92B3.22913
• 5 Porter M, Armstrong R, Howard P. et al. Orthopaedic registries – the UK view (National Joint Registry): impact on practice. EFORT Open Rev 2019; 4: 377-390 doi:10.1302/2058-5241.4.180084
• 6 Rolfson O, Eresian Chenok K, Bohm E. et al. Patient-reported outcome measures in arthroplasty registries. Acta Orthop 2016; 87 (Suppl. 01) S3-S8 doi:10.1080/17453674.2016.1181815
• 7 Wilson I, Bohm E, Lübbeke A. et al. Orthopaedic registries with patient-reported outcome measures. EFORT Open Rev 2019; 4: 357-367 doi:10.1302/2058-5241.4.180080
• 8 Haas H, Grifka J, Günther K-P, Heller K-D, Niethard FU, Windhagen H, Ebner M, Mittelmaier W. Hrsg. EndoCert^®. Zertifizierung von endoprothetischen Versorgungszentren in Deutschland. Eine Initiative der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC) mit Unterstützung der Arbeitsgemeinschaft Endoprothetik (AE) in der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) und des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie (BVOU). Stuttgart, New York: Thieme; 2013
• 9 Osmanski-Zenk K, Oskina A, Bader R. et al. Machbarkeitsstudie zum Einsatz verschiedener Patient-related Outcome Measurements in einem zertifizierten EndoProthetikZentrum. Z Orthop Unfall 2019; 157: 501-509 doi:10.1055/a-0820-6142
• 10 Murray DW, Fitzpatrick R, Rogers K. et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89: 1010-1014 doi:10.1302/0301-620X.89B8.19424
• 11 Harris KK, Price AJ, Beard DJ. et al. Can pain and function be distinguished in the Oxford Hip Score in a meaningful way?: an exploratory and confirmatory factor analysis. Bone Joint Res 2014; 3: 305-309 doi:10.1302/2046-3758.311.2000313
• 12 Harris K, Dawson J, Doll H. et al. Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 2013; 22: 2561-2568 doi:10.1007/s11136-013-0393-x
• 13 Cohen J. A Power Primer. Psychol Bull 1992; 112: 155-159 doi:10.1037/0033-2909.112.1.155
• 14 Gignac GE, Szodorai ET. Effect size guidelines for individual differences researchers. Pers Individ Dif 2016; 102: 74-78 doi:10.1016/j.paid.2016.06.069
• 15 Rolfson O, Bohm E, Franklin P. et al. Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87 (Suppl. 01) S9-S23 doi:10.1080/17453674.2016.1181816
• 16 Dawson J, Doll H, Fitzpatrick R. et al. The routine use of patient reported outcome measures in healthcare settings. BMJ 2010; 340: c186 doi:10.1136/bmj.c186
• 17 Gemeinsamer Bundesausschuss. Richtlinie des Gemeinsamen Bundesausschusses zur datengestützten einrichtungsübergreifenden Qualitätssicherung – DeQS-RL. Im Internet (Stand: 14.10.2020): https://www.g-ba.de/richtlinien/105/
• 18 Gemeinsamer Bundesausschuss. Pressemitteilung/Qualitätssicherung: Patientenbefragungen werden Teil von Qualitätssicherungsverfahren. Berlin, 19. Dezember 2019. Im Internet (Stand: 14.10.2020): https://www.g-ba.de/presse/pressemitteilungen/834
• 19 Niemeyer A, Marx J-F. „Patient reported outcome measurements“ in Orthopädie und Unfallchirurgie. Unfallchirurg 2020; 123: 342-347 doi:10.1007/s00113-020-00800-y
• 20 Malzahn J. Konservative und operative Behandlung von Gonarthrosepatienten im Erwerbsalter. Ökonomische Betrachtung. Orthopäde 2014; 43: 503-506 508–510 doi:10.1007/s00132-014-2295-1
• 21 Kalairajah Y, Azurza K, Hulme C. et al. Health outcome measures in the evaluation of total hip arthroplasties–a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 2005; 20: 1037-1041 doi:10.1016/j.arth.2005.04.017
• 22 Devane P, Horne G, Gehling DJ. Oxford hip scores at 6 months and 5 years are associated with total hip revision within the subsequent 2 years. Clin Orthop Relat Res 2013; 471: 3870-3874 doi:10.1007/s11999-013-2880-3
• 23 Beard DJ, Harris K, Dawson J. et al. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 2015; 68: 73-79 doi:10.1016/j.jclinepi.2014.08.009
• 24 Bischoff-Ferrari HA, Lingard EA, Losina E. et al. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum 2004; 51: 829-835 doi:10.1002/art.20691
• 25 Quintana JM, Escobar A, Aguirre U. et al. Predictors of Health-related Quality-of-life Change after Total Hip Arthroplasty. Clin Orthop Relat Res 2009; 467: 2886-2894 doi:10.1007/s11999-009-0868-9
• 26 Maillot C, Harman C, Al-Zibari M. et al. Moderate relationship between function and satisfaction of total hip arthroplasty patients: a cross sectional study. Hip Int 2020; DOI: 10.1177/1120700020921110.
• 27 Teni FS, Burström K, Berg J. et al. Predictive ability of the American Society of Anaesthesiologists physical status classification system on health-related quality of life of patients after total hip replacement: comparisons across eight EQ-5D-3 L value sets. BMC Musculoskelet Disord 2020; 21: 441 doi:10.1186/s12891-020-03399-8
• 28 Judge A, Arden NK, Kiran A. et al. Interpretation of patient-reported outcomes for hip and knee replacement surgery: identification of thresholds associated with satisfaction with surgery. J Bone Joint Surg Br 2012; 94: 412-418 doi:10.1302/0301-620X.94B3.27425
• 29 Keurentjes JC, van Tol FR, Fiocco M. et al. Patient acceptable symptom states after total hip or knee replacement at mid-term follow-up: Thresholds of the Oxford hip and knee scores. Bone Joint Res 2014; 3: 7-13 doi:10.1302/2046-3758.31.2000141
• 30 Krueger DR, Leopold VJ, Schroeder JH. et al. Correlation of the Subjective Hip Value with Validated Patient-Reported Outcome Measurements for the Hip. J Clin Med 2020; 9: 2179 doi:10.3390/jcm9072179