New model for identifying total hip replacement candidates

Researchers at Sahlgrenska Academy have designed a new model to help doctors and patients decide whether or not to proceed with total hip replacement surgery. The researchers have also surveyed patient wellbeing after surgery: patients with high education achieve greater outcome scores, while those with antidepressant prescriptions do not.

University of Gothenburg researchers have been following patients entered in the Swedish Hip Arthroplasty Register since the 1970s and started conducting systematic health surveys in 2002.

Data from the surveys, Statistics Sweden, the National Patient Register and the Prescribed Drug Register have allowed the researchers to describe patient-reported pain, health-related quality of life, and satisfaction with treatment.

Detailed analysis

Based on a detailed analysis of gender, age, marital status, education and comorbidity, the study has determined that high educational level is associated with better outcomes after total hip replacement surgery. Patients with preoperative antidepressant prescriptions or problems with both hips report lower scores after surgery.

Identifies promising candidates

The researchers have also designed a decision tool based on assessments of more than 300 patients with hip pain by orthopedic specialists at Massachusetts General Hospital in Boston. The model may help doctors and patients identify the most promising candidates for total hip replacement surgery.

"Our tests found that the decision tool model can predict with a high degree of accuracy whether or not a patient will be recommended for total hip replacement surgery," says Meridith Greene, PhD student at Sahlgrenska Academy, University of Gothenburg.

Reasonable expectations

A similar model, which is to be upgraded and tested in clinical practice, will soon be used for Swedish patients.

"Our purpose is not to discourage any specific patient groups from receiving surgery," Ms. Greene says. "Understanding the influence of these patient-related factors will aid shared decision-making about total hip replacement between clinicians and individual patients, as well as ensure reasonable expectations about outcomes."