Elsevier

Injury

Volume 42, Issue 3, March 2011, Pages 259-264
Injury

Measuring hip outcomes: Common scales and checklists

https://doi.org/10.1016/j.injury.2010.11.052Get rights and content

Abstract

Introduction

Assessing the outcomes of patients following surgical interventions is a challenging task. Traditionally the end results of joint replacement were based on morbidity/mortality rates and operative complications. The modern approach to outcomes following Orthopaedic surgery has shifted from the success or failure of implants towards patient satisfaction and the quality of life achieved. The aim of this paper was to identify and analyse the common scoring systems present in the medical literature for evaluating outcomes after hip interventions.

Methods

A pub-med search was performed using terms ‘scoring system, functional outcomes, hip joint’. Specific limitations and exclusion criteria were used and the reference lists of the articles included in the study were subjected to further analysis for identification of additional relevant papers.

Results

293 articles were identified of which 40 met the inclusion criteria. The outcome measures were divided into: (i) hip specific outcomes, (ii) disease-specific measures and (iii) generic quality of life measures. Based on our analysis, we would recommend a combination of the hip specific Oxford Hip Score (OHS) and the disease specific WOMAC score. The OHS is quick and easy to complete, has a very high response rate and is free from clinician bias. On the other hand, the majority of hip pathology is related to degenerative disease, thus making the WOMAC the most appropriate measure to use. Where comparison between different conditions is required, then an additional generic quality of life (QOL) score, such as EQ5D, that can enable comparisons in cost-effectiveness term can be used.

Conclusion

The ideal outcome measure should be one that is specific for the hip joint, possesses a generic component and takes into consideration co-morbidities and the use of walking aids. Although many validated generic measures exist, additional validation studies, including the OHS, are desirable to evaluate all the hip specific measures of outcome.

Introduction

Following the introduction of total joint replacement by Sir John Charnley in the 1960s, lower limb arthroplasty has become a successful surgical procedure, enabling patients to return to high levels of function. http://www.ejbjs.org/cgi/content/full/86/5/963 – REF1 assessing the outcomes of patients following such interventions can be a challenging task. Nonetheless, patients and surgeons may be at variance in their concerns and priorities.

Traditionally the end points of joint replacement were based on morbidity & mortality rates and operative complications. Lately however, the assessment of outcomes in orthopaedic surgery has shifted from success or failure of an implant towards patient satisfaction and the quality of life achieved.31 Outcome measures enable improvements in pain, range of movement, mental state, and overall quality of life to be ascertained. A variety of quality of life evaluation tools have been developed that differ in their measurement techniques and in the number of domains they assess. http://www.ejbjs.org/cgi/content/full/86/5/963 – REF24 an ideal scoring system that can be applied universally to all patients after operative procedures has yet to be proposed, but scoring systems for specific anatomical sites have been developed.

In this study, the currently available scoring systems that can be utilised to assess functional outcomes of the hip joint are evaluated.

Section snippets

Materials and methods

Using the pub med search engine articles relevant to functional outcome of the hip joint were identified. Mesh words used were ‘scoring system, functional outcome, hip joint’. The limits used were: Humans, Editorial, Classical Article, English Abstract, Introductory Journal Article, Journal Article, English, Core clinical journals, Systematic Reviews, Medline, PubMed Central, All Adult: 19+ years. Exclusion criteria were scoring systems not relevant to hip joint and language other than English.

Results

Between January 1940 and January 2010 out of 293 articles identified, 40 met the inclusion criteria.2, 6, 7, 8, 10, 12, 13, 14, 16, 17, 21, 22, 24, 27, 31, 33, 34, 38, 39, 40, 41, 48, 50, 51, 52, 58, 60, 62 These were categorised to three subgroups: (i) scoring systems specific for hip outcome measures,8, 10, 24, 33, 34, 41, 44, 58 (ii) disease-specific quality-of-life outcome measures 2, 14, 29, 54, 60 and (iii) generic quality of life outcome scoring systems 13, 27, 30, 32, 36, 37, 48, 49, 56

Discussion

Modern day medical practice, especially in the field of Trauma and Orthopaedics requires surgeons to be able to demonstrate outcomes of their interventions in both the field of elective and trauma surgery.3, 22, 29, 43, 51 Economic considerations, patient expectations and the development of a wide range of implants are all factors influencing the use of health outcome measures. Site specific questionnaires have been developed in Orthopaedic surgery to enable documentation of the pre-surgical

Conclusions

The ideal hip outcome measure should be one that is specific for the hip joint, possesses a generic component, is clear & concise and takes into consideration co-morbidities and the use of walking aids. The current available outcome measures all have limitations (Table 1) and do not individually fulfil these requirements, thus a combination of health outcome measures are used.

For the hip joint we would recommend a combination of the hip specific OHS and the disease specific WOMAC score. The OHS

Conflict of interest

The authors declare no conflict of interest regarding the work of this paper.

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