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Evaluation by explicit criteria of the use of total hip joint replacement
J M Quintana1, I Aróstegui, J Azkarate
1Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain.
Insights
A significant portion of total hip replacements (THR) were found to be inappropriate or uncertain, indicating a need to better identify patients who may not benefit from this surgery.
Area of Science:
- Orthopedic Surgery
- Health Services Research
Background:
- Total hip replacement (THR) is a common procedure for osteoarthritis.
- Evaluating the appropriateness of THR is crucial for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To assess the appropriateness of total hip replacement (THR) indications using expert-developed criteria.
- To identify potential overuse or misapplication of THR in a public healthcare setting.
Main Methods:
- A consecutive series of 583 patients undergoing THR for osteoarthritis in five Spanish public hospitals were evaluated.
- Explicit criteria, developed through a multidisciplinary approach, were used to judge the appropriateness of each THR indication.
- Patient outcomes, including complications, pain, functional limitation, and general health, were assessed post-surgery.
Main Results:
- Approximately 13.6% of THRs were deemed inappropriate, and 46.2% had uncertain indications.
- Variations in appropriateness rates were observed across different hospitals.
- Patients with appropriate THR indications reported slightly better general health one year after discharge compared to those with uncertain or inappropriate procedures.
Conclusions:
- A considerable percentage of total hip replacements (THR) were performed inappropriately or with uncertain indications.
- Further research is needed to refine patient selection and identify individuals with an unfavorable benefit:risk ratio for THR.
Objective:
To evaluate the appropriateness of the use of total hip replacement (THR) using explicit criteria developed by an expert panel.
Methods:
Patients with a diagnosis of osteoarthritis who were undergoing THR in five public hospitals in Spain were included consecutively in the study during a 1-yr period. The appropriateness of the indication was judged by explicit criteria developed using a mutidisciplinary approach. Complications were measured 3 months after surgery. One year after discharge, pain, functional limitation and general health were measured.
Results:
After evaluation of 583 patients, 82 (13.6%) were considered to have undergone inappropriate procedures, and for 279 (46.2%) patients indication for the procedure was considered uncertain. Differences were found in the rate of appropriateness among some centres. One year after discharge, the perception of general health was slightly better in those patients who had been judged to have undergone an appropriate procedure.
Conclusions:
The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure.