Early patient-reported outcomes from primary hip and knee arthroplasty have improved over the past seven years: an analysis of the NHS PROMs dataset

Journal article

Introduction Routinely-collected patient-reported outcome measures (PROMs) have been useful to quantify and quality-assess provision of total hip replacement (THR) and total knee replacement (TKR) in the UK for the past decade. This study aimed to explore whether the outcome following primary THR and TKR has improved over the past seven years.
Methods Secondary data analysis of 277,430 primary THR and 308,007 primary TKR from the NHS PROMs programme. Outcome measures were: (i) post-operative Oxford hip/knee score (OHS/OKS); (ii) proportion of patients achieving a clinically important improvement in joint function (responders); (iii) quality of life; (iv) patient satisfaction; (v) perceived success; and (vi) complication rates. Outcomes were compared based on year of surgery.
Results For primary THR, more recent year of surgery was associated with higher post-operative OHS (0.15 points, 95% confidence interval (CI) 0.14-0.17; p<0.001) and higher EQ-5D utility (0.002, 95% CI 0.001-0.002; p<0.001). The odds of being a responder (OR 1.02, 95% CI 1.01-1.03; p<0.001) and patient satisfaction (OR 1.02, 95% CI 1.01-1.03; p<0.001) increased with year of surgery, whilst the odds of any complication reduced (OR 0.97, 95% CI 0.97-0.98; p<0.001). No trend was found for perceived success (p=0.56). For primary TKR, more recent year of surgery was associated with higher post-operative OKS (0.21 points, 95% CI 0.19-0.22; p<0.001) and higher EQ-5D utility (0.002, 95% CI 0.002-0.003; p<0.001). The odds of being a responder (OR 1.04, 95% CI 1.03-1.04; p<0.001), perceived success (OR 1.02, 95% CI 1.01-1.02; p<0.001) and patient satisfaction (OR 1.02, 95% CI 1.01-1.02; p<0.001) all increased with year of surgery, whilst the odds of any complication reduced (OR 0.97, 95% CI 0.97-0.97; p<0.001).
Conclusion Nearly all patient-reported outcomes following primary THR/TKR improved by a small amount over the past seven years. Due to the high proportion of patients achieving good outcomes, PROMs following THR/TKR may need to focus on better discrimination of patients achieving high scores to be able to continue to measure improvement in outcomes.

Authors: Sabah, SA; Knight, R; Alvand, A; Price, AJ; Beard, DJ

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone and Joint Journal
• Volume: 104-B
• Issue: 6
• Pages: 687-695
• Publication date: 2022-05-31
• Acceptance date: 2022-04-05
• DOI: 10.1302/0301-620X.104B6.BJJ-2021-1577.R1
• EISSN: 2049-4408
• ISSN: 2049-4394
• Language: English
• Keywords: hip and knee arthroplasty; Oxford Hip Score (OHS); total hip arthroplasty; hip; patient-reported outcome measures; patient-reported outcome measures (PROMs); linear regression modelling; primary total hip arthroplasty; knee arthroplasty procedures; total knee arthroplasty; complications; EQ-5D; total knee arthroplasty (TKA); primary TKAs