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WHY DO THOSE PATIENTS WITH A LOW-PRE-OPERATIVE OXFORD HIP SCORE UNDERGO HIP ARTHROPLASTY?



Abstract

Introduction: The Oxford hip score (OHS) instrument is used to assess pain and disability before and after hip arthroplasty and may be used as a standard for auditing pre and post-operative patients. It has been suggested that patients with a low pre-operative hip score (< 25th percentile) should be carefully assessed before surgical management is employed. This study aimed to determine the factors that influence a surgeon’s decision to undertake hip arthroplasty in patients with a low pre-operative hip score.

Methods: All patients who underwent hip arthroplasty over a two month period (n=121) were included. Of these, four pre-operative OHS questionnaires were missing. The remaining (117) were validated and those scoring below the published 25th percentile (58.3%) were selected (n=35), termed the ‘low-group’. Individual OHS responses scored 0–4 were examined (0 = no impairment and 4 = worst impairment) and the proportional differences between the responses for this group and the remaining 75% were investigated. The pre-operative radiographic Tönnis stage of osteoarthritis was determined.

Results: The median cohort OHS was 68.8% (IQR = 50–79%). Of the questions that scored highly, 59% were purely pain related, 14% function and 27% both. 66% of patients experienced moderate/severe pain and 31% suffered night pain. The ‘low-group’ never scored 4 (worst impairment) on questions concerning washing, transport, shopping, stairs and work. However, 57% scored 4 on questions encompassing a pain component. In all questions except donning socks and walking, the proportion of 4 in the ‘low-group’ was significantly different to the remainder of the cohort. Tönnis grade 3 (osteophytes and advanced loss of joint space) osteoarthritis predominated (49%).

Conclusion: Arthroplasty in patients with low pre-operative OHS is influenced mainly by pain affecting quality of life. Half of these patients also have advanced features of osteoarthritis on radiographic assessment despite the low scores.

Correspondence should be addressed to: British Hip Society, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England. Email: c.wilson@boa.ac.uk