Olwen Williams | PubMed Health

PubMed2002

Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty.

No representative data exist on the risks of adverse outcomes of total hip arthroplasty (THA) in the United Kingdom. A prospective observational study of unselected THA operations was carried out in 5 U.K. regions. Adverse outcomes were assessed from the hospital case notes and general practitioners of 1,100 randomly selected patients and from 7,151 patient-completed questionnaires 3 and 12 months after THA. Three-month mortality was 0.4% to 0.7%. Dislocation and thromboembolic complications were about 3% and 4%. Perioperative fracture, sciatic nerve palsy, aseptic loosening, and revision each had a risk of < or = 1%. At 1 year, 2.6% of patients had undergone another operation on the same hip, 11% reported moderate or severe pain in the operated hip, 23% had severe walking restriction, and 11% were dissatisfied with the operation. Patients and surgeons in the United Kingdom should have access to this information when making a decision about THA.

Arthroplasty, Replacement, Hip↗

PubMed2002

Does waiting for total hip replacement matter? Prospective cohort study.

OBJECTIVES: To assess the impact on the outcome of total hip replacement of the length of timing spent waiting for surgery. METHODS: One hundred and forty-three orthopaedic and general hospitals provided information about aspects of surgical practice for each total hip replacement conducted between September 1996 and October 1997 for publicly and privately funded operations in five English health regions. These data were linked to patient information about hip-related pain and disability status (measured using the Oxford Hip Score) before operation and at 3 and 12 months after. Data were analysed using multiple regression analysis. RESULTS: Questionnaires were completed by surgeons for 10,410 (78%) patients treated during the recruitment period and by 7151 (54%) patients. Twelve months after total hip replacement, the majority of patients experienced substantial improvements in hip-related pain and disability (as measured by the Oxford Hip Score). Those patients who started with a worse Oxford Hip Score before the operation tended to remain worse after the operation. Worse pre-operative score was associated with an increased length of either outpatient or inpatient wait, and this trend remained after the operation. The relationship between waiting time and outcome remained after adjustment for possible confounding variables. A consistently worse score was observed in public compared with private patients at all three time-points. In addition, in both sectors, those patients who were socially disadvantaged had a worse score than more socially advantaged patients both before and after the operation. CONCLUSIONS: Waiting for surgery is associated with worse outcomes 12 months later. Longer-term outcome needs to be considered to see if this association persists.

Activities of Daily Living↗