Predicting changes in the status of patient-reported outcome measures after Birmingham Hip Resurfacing

Abstract

Aims It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. Patients and Methods Patients undergoing Birmingham Hip Resurfacing completed the Veteran’s Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. Results Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. Conclusion Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431–1437.

Time for return to sport following total hip arthroplasty: a meta-analysis

“…31 Patient-reported outcome measures (PROMS) play an important role in monitoring progress following THA. [32][33][34][35][36][37] Numerous functional scoring systems were used in the studies included in this meta-analysis. The UCLA activity score is a validated scoring system that is often used following total joint arthroplasty.…”

Long-term blood metal ion levels and clinical outcome after Birmingham hip arthroplasty

“…2 As for MoM total hip arthroplasties (THAs), implant survival of most MoM hip resurfacing arthroplasty (HRA) brands have been poor compared to conventional bearing surfaces. 3 However, the Birmingham hip resurfacing (BHR HRA, Smith & Nephew, London, United Kingdom) device is still in scarce use especially in England and Australia 4,5 due to satisfying outcome compared to other HRA brands. 6,7 The 10-year overall survival rate for all HRA has been 86% while BHR HRA has 91% 10-year survival in Finland.…”