Related Experiment Video
Updated: Sep 18, 2026
The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
Published on: August 4, 2022
A Nomogram for Predicting Non-Response to Surgery One Year after Elective Total Hip Replacement
Michelle M Dowsey1,2, Tim Spelman1, Peter F M Choong1,2
1Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia.
Insights
This study developed a prognostic nomogram to predict non-response to total hip replacement (THR) surgery. The tool identified key factors like obesity and comorbidities, aiding in better patient selection for THR.
Area of Science:
- Orthopedics
- Prognostic modeling
Background:
- Total hip replacement (THR) is a common procedure for end-stage osteoarthritis.
- Inappropriate utilization may impact the perceived effectiveness of THR.
- Developing predictive tools is crucial for optimizing THR outcomes.
Purpose of the Study:
- To develop and internally validate a prognostic algorithm predicting non-response to THR at one year.
- To identify key prognostic factors associated with THR non-response.
Main Methods:
- Analysis of 2177 elective THR cases from an institutional registry (2012-2019).
- Application of OMERACT-OARSI responder criteria using Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores.
- Development of a nomogram based on independent prognostic correlates of non-response.
Main Results:
- 8.9% of patients were identified as non-responders to THR.
- Predictive factors for non-response included morbid obesity, Kellgren-Lawrence grade <4, and comorbidities (cerebrovascular, chronic pulmonary, connective tissue disease, diabetes, liver disease).
- The developed nomogram achieved a concordance index of 0.70.
Conclusions:
- A prognostic nomogram for predicting THR non-response has been developed.
- Prognostic factors for THR non-response differ from those for total knee replacement (TKR).
- Condition and surgery-specific decision support tools are beneficial; external validation of the THR nomogram is needed.
Abstract:
Background: Total hip replacement (THR) is a common and cost-effective procedure for end-stage osteoarthritis, but inappropriate utilization may be devaluing its true impact. The purpose of this study was to develop and test the internal validity of a prognostic algorithm for predicting the probability of non-response to THR surgery at 1 year. Methods: Analysis of outcome data extracted from an institutional registry of individuals (N = 2177) following elective THR performed between January 2012 and December 2019. OMERACT-OARSI responder criteria were applied to Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scores at pre- and 1 year post-THR, to determine non-response to surgery. Independent prognostic correlates of post-operative non-response observed in adjusted modelling were then used to develop a nomogram. Results: A total of 194 (8.9%) cases were deemed non-responders to THR. The degree of contribution (OR, 95% CI) of each explanatory factor to non-response on the nomogram was, morbid obesity (1.88, 1.16, 3.05), Kellgren−Lawrence grade <4 (1.89, 1.39, 2.56), WOMAC Global rating per 10 units (0.86, 0.79, 0.94) and the following co-morbidities: cerebrovascular disease (2.39, 1.33, 4.30), chronic pulmonary disease (1.64; 1.00, 2.71), connective tissue disease (1.99, 1.17, 3.39), diabetes (1.86, 1.26, 2.75) and liver disease (2.28, 0.99, 5.27). The concordance index for the nomogram was 0.70. Conclusion: We have developed a prognostic nomogram to calculate the probability of non-response to THR surgery. In doing so, we determined that both the probability of and predictive prognostic factors for non-response to THR differed from a previously developed nomogram for total knee replacement (TKR), confirming the benefit of designing decision support tools that are both condition and surgery site specific. Future external validation of the nomogram is required to confirm its generalisability.
More Related Videos
06:17Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head
Published on: April 12, 2022
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
