Patient-reported outcome in total hip replacement. A comparison of five instruments of health status.

Our aim was to define the minimum set of patient-reported outcome measures which are required to assess health status after total hip replacement (THR). In 114 patients, we compared the pre-operative characteristics and sensitivity to change of the Oxford hip score (OHS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the SF-36, the SF-12 (derived from the SF-36), and the Euroqol questionnaire (EQ-5D). At one year after operation, very large effect sizes were found for the disease-specific measures, the physical domains of the SF-12, SF-36 and the EQ-5Dindex (1.3 to 3.0). Patients in Charnley class A showed more change in the OHS, WOMAC pain and function, the physical domains of the SF-36 and the EQ-5Dvas (p < 0.05) compared with those in the Charnley B and C group. In this group, the effect size for the OHS more than doubled the effect sizes of WOMAC pain and physical function. We found high correlations and correlations of change between the OHS, the WOMAC, the physical domains of the SF-12 and the SF-36 and EQ-5Dindex. The SF-36 and EQ-5D scores at one year after operation approached those of the general population. Furthermore, we found a binomial distribution of the pre-operative EQ-5Dindex score and a pre-operative discrepancy and post-operative agreement between the EQ-5Dvas and EQ-5Dindex. We recommend the use of the OHS and SF-12 in the assessment of THR. The SF-36 may be used in circumstances when smaller changes in health status are investigated, for example in the follow-up of THR. The EQ-5D is useful in situations in which utility values are needed in order to calculate cost-effectiveness or quality-adjusted life years (QALYs), such as in the assessment of new techniques in THR.

[Satisfactory results of surgical reconstruction of rotator cuff ruptures, 1984-1990]. / Bevredigende resultaten van operatieve reconstructie van 'rotator cuff'-rupturen, 1984-1990.

OBJECTIVE: Evaluation of the middle-long term results of open surgical treatment of rotator cuff tears and identification of pre- and peroperative parameters with predictive value for the final result. DESIGN: Retrospective study (1984-1990). SETTING: Department of orthopaedics of the Sint Antonius Hospital, Nieuwegein, the Netherlands. METHOD: All patients were asked to cooperate on an extensive standard anamnesis and physical examination. Re-evaluation of the X-rays, arthrograms and operation reports took place. There were three stragglers. RESULTS: The follow-up concerned 41 shoulders in 40 patients (21 women, 19 men). The average age was 61 years (37-77). The average postoperative period was 5 years (2.5-9.2). The subjective final result was satisfactory in 80% as judged by persistent complaints and function of the operated shoulder. Young and active patients were less satisfied with the final result than older, female patients. More persistent complaints were seen in larger and longer existing cuff tears. CONCLUSIONS: Open surgical treatment of rotator cuff tears gave a satisfying result, as described in literature. Sex, age, level of activity and size of the tear appeared to be predictive parameters for the subjective final result.