Measuring hip outcomes: Common scales and checklists
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.
References (62)
- et al.
Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up
Injury
(2010) - et al.
Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation)
Injury
(2009) - et al.
Functional outcome and health status of injured patients with peripheral nerve lesions
Injury
(2010) - et al.
Predicting quality-of-life outcomes following total joint arthroplasty
J Arthroplasty
(1995) - et al.
The Harris Hip Score: comparison of patient self report with surgeon assessment
J Arthroplasty
(2001) - et al.
Adaptation and validation of the SF-36 health survey for use in Australia
J Clin Epidemiol
(1998) - et al.
Functional outcomes and health-related quality of life after intramedullary nailing of tibia shaft fractures
Injury
(2009) - et al.
Test–retest reliability of health state valuations collected with the EuroQol questionnaire
Soc Sci Med
(1994) - et al.
Outcome assessment in the elderly after total hip arthroplasty
J Arthroplasty
(2006) - et al.
Reliability, validity, and sensitivity of a Swedish version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2)
Rheumatololgy
(1997)