Patient-reported outcome measures for hip and knee arthroplasty in Ontario, Canada
Steven Habbous1,2, Stephen Petersen1, Calum Thompson1
1Ontario Health, 525 University Ave., Toronto, Ontario, Canada.
Introduction:
Increasing uptake of hip and knee arthroplasty to outpatient settings is an attractive option to shorten wait-times, reduce health system costs, and relieve hospital pressures, but the impact on patient-reported outcome measures (PROMs) is unclear.
Methods:
We examine the population-level uptake of orthopedic PROMs (EuroQoL-5D-5L; Oxford Hip/Knee Score) in Ontario, Canada since April 1, 2019. We explored factors associated with completion of pre-operative survey; PROMs scores; and reaching a minimal clinically significant improvement (MCSD).
Results:
From 01Apr2024-31Mar2025, 41% (n = 19130) completed a pre-operative survey within 2 months of surgery, 14% completed a 3-5 month postoperative survey, and 15% completed a 9-15 month postoperative survey. Substantial hospital-level variation in reporting was observed. Pre-operative Oxford scores were higher (better) among outpatients (mean difference 1.8 points), and lower for females (-2.4 points), patients undergoing hip replacement (-2.1 points), and patients having higher comorbidity. A MCSD was observed for 53% of patients 3-5 months post-operatively and was more likely among outpatients [OR 1.28 (1.12-1.45)], hip replacement patients, rural residents, and among those having a higher baseline EQ5D score. Patients were less likely to reach the MCSD if they had a comorbidity score ≥4, if they resided in a long-term care setting, or resided in areas with higher concentrations of racialized or newcomer populations.
Conclusion:
Efforts to improve orthopedic PROMs reporting have had some success, but completion rates fall short of the 60% target. There was no evidence that patients undergoing outpatient hip/knee arthroplasty experienced worse QoL than inpatients, supporting ongoing efforts to promote outpatient surgery.
