Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres
Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres
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DOI：
10.1186/1471-2474-10-19
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发表时间：
2009-02-10
影响因子：
2.3
通讯作者：
Dreinhoefer, Karsten
中科院分区：
文献类型：
--
作者：
Dieppe, Paul;Judge, Andrew;Dreinhoefer, Karsten
背景：全髋关节置换术（THR）是治疗髋关节骨关节炎（OA）的一种高容量、有效的干预措施。然而，结果的适应症和决定因素仍不清楚。“EUROHIP联合体”已经进行了一项队列研究来调查这些问题。本文介绍了在这个队列中的疾病严重程度的变化和临床和影像学的严重程度之间的关系，并探讨了一些变化的决定因素。方法：至少有50个连续的，同意的患者在20个参与骨科中心的每一个主要髋关节OA的主要THR进入研究。术前数据包括人口统计学、就业和教育程度、药物使用和其他关节受累。每例受试者完成了西安大略和麦克马斯特大学骨关节炎指数（WOMAC - Likert版本3.1）。手术时收集的其他数据包括所用假体和美国麻醉医师协会（阿萨）状态。术前X线片由相同的三名阅片员阅读Kellgren和Lawrence（K&L）分级和国际骨关节炎研究学会（OARSI）图谱特征。结果：对1327例受试者的数据进行了回归分析。这一群体的平均年龄为65.7岁，女性（53.4%）多于男性。大多数（79%）为阿萨1级或2级。69.2%报告的疾病持续时间为5年或更短。1051名受试者有X线片，95.8%的受试者K&L分级为3或4级。临床严重程度（WOMAC评分）的变化更大;平均总WOMAC评分为59.2（SD 16.1）。影像学严重程度与WOMAC评分无相关性，老年人、女性、肥胖者、一般健康状况较差者、文化程度较低者WOMAC评分明显较高（病情较重）。临床疾病的严重程度在全髋关节置换术时变化很大。晚期髋关节OA的临床严重程度与影像学严重程度无相关性.简单的疼痛和残疾评分并不能反映出关于谁应该接受THR的决策的复杂性。
Background: Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation.Methods: A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC - Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Preoperative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out.Results: Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common.Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores.Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment.Conclusion: 1. Clinical disease severity varies widely at the time of THR for OA.2. In advanced hip OA clinical severity shows no correlation with radiographic severity.3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR.