Elsevier

The Journal of Arthroplasty

Volume 17, Issue 2, February 2002, Pages 165-171
The Journal of Arthroplasty

Original Articles
Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty*,**,

https://doi.org/10.1054/arth.2002.29389Get rights and content

Abstract

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 ≤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.

Section snippets

Methods

All consultant orthopaedic surgeons in 5 U.K. regions (East Anglia, Oxford, Trent, Northern, and Yorkshire) were invited to participate, by supplying operative data about every primary elective THA operation in National Health Service (NHS) and private hospitals during a 12-month period in 1996–1997. Consecutive patients listed for THA were asked to complete questionnaires preoperatively and at 3 and 12 months postoperatively. These questionnaires included the 12 items of the Oxford Hip Score

Results

Of 379 surgeons thought to be undertaking THA surgery at that time, 300 (79%) agreed to participate, 13 (3%) refused to participate, and 66 (17%) did not reply to the request to participate in this study. Data were collected from 143 hospitals, with 1 NHS and 2 private hospitals refusing to take part. The total number of THA operations carried out in participating hospitals during the study period was estimated from operating room records to be 13,343 (10,948 NHS and 2,395 private), and a

Discussion

Improvements in health status and mobility, as measured by the use of the OHS [13] and other questionnaires, can be used to assess the positive outcomes of hip surgery. In this study, large and important overall improvements in symptoms were observed 16, 17. It is equally important, however, for patients and surgeons to consider the risk of adverse outcomes when making a decision to undergo THA, and it has been recommended that deaths occurring within 3 months of operation, revision rates, and

Conclusion

This study provides the best information to date about the risk of adverse outcomes of THA when practiced in the general setting of the U.K. health care system. We are not aware of the availability of similar information for other countries, although other outcomes (eg, revision rates and mortality) have been reported by the Swedish and Norwegian Registries 3, 4, 19. Patients undergoing THA in the United Kingdom should have access to this information when making a decision whether to undergo

Acknowledgements

The National Total Hip Replacement Outcome Study (NTHROS) was a collaborative project between the British Orthopaedic Association and the Clinical Effectiveness Unit of the Royal College of Surgeons. We thank the research coordinators in the regions (Victoria Bridgett, June Stefanelli, Joanne Staniland, and Louisa Clements) for their help with data collection and abstraction of information from clinical records. We also thank members of the NTHROS steering committee not listed as authors: the

References (30)

  • British Orthopaedic Association

    Total hip replacement: a guide to best practice

    British Orthopaedic Association

    (2000)
  • BM Wroblewski et al.

    Charnley low-friction arthroplasty of the hip: long-term results

    Clin Orthop

    (1993)
  • H Malchau et al.

    Prognosis of total hip replacement in Sweden: follow up 92,675 operations performed 1978–1990

    Acta Orthop Scand

    (1993)
  • B Espehaug et al.

    The effect of hospital-type and operating volume on the survival of hip replacements: a review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, 1988–1996

    Acta Orthop Scand

    (1999)
  • D Fender et al.

    Outcome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip register

    J Bone Joint Surg Br

    (1999)
  • GH Guyatt et al.

    Users' guides to the medical literature: II. how to use an article about therapy or prevention: A. are the results of the study valid?

    JAMA

    (1993)
  • A Faulkner et al.

    Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model. p 7-10, Types of Outcomes Measure

    Health Technol Assess

    (1998)
  • BC Reeves

    Principles of research: design and analysis of clinical trials

    Surgery

    (2000)
  • NHS Management Executive: Assessing the effects of health technologies

    (1992)
  • J Heaton et al.

    Measuring the health outcomes of total hip replacement through the commissioning process. Outcome Measurement Reviews No. 1

    (1995)
  • J Ivory et al.

    Total hip replacement

    Qual Health Care

    (1994)
  • MH Williams et al.

    Total hip replacement

    Health Care Needs Assess

    (1994)
  • J Dawson et al.

    Questionnaire on the perceptions of patients about total hip replacement

    J Bone Joint Surg Br

    (1996)
  • R Fitzpatrick et al.

    The value of short and simple measures to assess outcomes for patients of total hip replacement surgery

    Qual Health Care

    (2000)
  • RW Morris et al.

    Primary total hip replacement: variations in patient management in Oxford and Anglia, Trent, Yorkshire and Northern “regions.”

    Ann R Coll Surg [Engl]

    (2001)
  • Cited by (80)

    • Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain

      2016, Journal of the National Medical Association
      Citation Excerpt :

      A neuropathic pain component is considered unlikely (<15% likely) for scores of 12 or less, whereas the results are considered uncertain for scores between 13 and 18 points.21 Patient satisfaction was assessed with a single question asking “If you had to be the rest of your life with the symptoms you have now, how would you feel?”22 Patients' satisfactions were evaluated using four point scale; 0 (very satisfied), 1 (satisfied), 2 (dissatisfied), 3 (very dissatisfied).23

    View all citing articles on Scopus
    *

    Benefits or funds were received in partial or total support of the research material described in this article from the Department of Health for England and Wales.

    **

    Reprint requests: Professor Paul J. Gregg, MD, FRCS, Middlesborough General Hospital and University of Durham, UK. E-mail: [email protected]

    On behalf of the National Total Hip Replacement Outcome Study Steering Committee.

    View full text