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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.
Journal of Clinical Medicine
|March 25, 2022
Summary
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.
