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

A. Judge, C. Cooper, N. K. Arden, S. Williams, N. Hobbs, D. Dixon, K. -P. Guenther, K. Dreinhoefer, P. A. Dieppe

Research output: Contribution to journalArticle

55 Citations (Scopus)

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 (Cl) 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. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

LanguageEnglish
Pages659-667
Number of pages9
JournalOsteoarthritis and Cartilage
Volume19
Issue number6
DOIs
Publication statusPublished - Jun 2011

Fingerprint

Hip Replacement Arthroplasties
Orthopedics
Surgery
Logistics
Education
Stiffness
Decision making
Costs
Body Mass Index
Replacement Arthroplasties
Logistic Models
Hip Osteoarthritis
Sex Education
Rheumatology
Ontario
Osteoarthritis
Decision Making
Outcome Assessment (Health Care)
Databases
Costs and Cost Analysis

Keywords

  • hip replacement
  • patient-reported outcome
  • expectation
  • decision-making
  • total knee arthroplasty
  • single health region
  • multiple imputation
  • joint arthroplasty
  • reported outcomes
  • osteoporosis
  • surgery
  • England
  • pain
  • satisfaction

Cite this

Judge, A. ; Cooper, C. ; Arden, N. K. ; Williams, S. ; Hobbs, N. ; Dixon, D. ; Guenther, K. -P. ; Dreinhoefer, K. ; Dieppe, P. A. / Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. In: Osteoarthritis and Cartilage. 2011 ; Vol. 19, No. 6. pp. 659-667.
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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 (Cl) 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. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.",
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Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. / Judge, A.; Cooper, C.; Arden, N. K.; Williams, S.; Hobbs, N.; Dixon, D.; Guenther, K. -P.; Dreinhoefer, K.; Dieppe, P. A.

In: Osteoarthritis and Cartilage, Vol. 19, No. 6, 06.2011, p. 659-667.

Research output: Contribution to journalArticle

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AU - Judge, A.

AU - Cooper, C.

AU - Arden, N. K.

AU - Williams, S.

AU - Hobbs, N.

AU - Dixon, D.

AU - Guenther, K. -P.

AU - Dreinhoefer, K.

AU - Dieppe, P. A.

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N2 - 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 (Cl) 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. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

AB - 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 (Cl) 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. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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KW - multiple imputation

KW - joint arthroplasty

KW - reported outcomes

KW - osteoporosis

KW - surgery

KW - England

KW - pain

KW - satisfaction

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