Dr. Maillefert has received consultant fees (less than $10,000) from Negma-Lerads laboratories and speaking fees (less than $10,000 each) from Wyeth, Abbott, Roche, and Eli Lilly. Drs. Cadet and Nizard have received consultant fees (less than $10,000) from Negma-Lerads laboratories. Dr. Ravaud has received consultant fees and speaking fees (less than $10,000 each) from Roche, Negma-Lerads laboratories, Schering, and Pfizer.
Factors influencing surgeons' decisions in the indication for total joint replacement in hip osteoarthritis in real life
Article first published online: 31 JAN 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 2, pages 255–262, 15 February 2008
How to Cite
Maillefert, J. F., Roy, C., Cadet, C., Nizard, R., Berdah, L. and Ravaud, P. (2008), Factors influencing surgeons' decisions in the indication for total joint replacement in hip osteoarthritis in real life. Arthritis & Rheumatism, 59: 255–262. doi: 10.1002/art.23331
- Issue published online: 31 JAN 2008
- Article first published online: 31 JAN 2008
- Manuscript Accepted: 2 JUL 2007
- Manuscript Received: 17 FEB 2007
- Negma-Lerads Laboratories
To evaluate factors influencing orthopedic surgeons' decision in daily practice to recommend or not recommend total hip arthroplasty (THA) in patients with hip osteoarthritis (OA).
General practitioners and rheumatologists were asked to prospectively include 1 patient with hip OA for whom a consultation with an orthopedic surgeon was planned to determine whether or not THA was indicated. The following variables were obtained: age, sex, occupational status, body mass index, comorbidities, duration of hip OA, patient's global assessment, Western Ontario and McMaster Universities Osteoarthritis Index pain and functioning subscale scores, New Zealand score, quality of life, and structural parameters on radiographs. The surgeon's decision was obtained by followup questionnaires. Statistical analysis evaluated potential predictors of the surgeon's decision (indication for THA within the next 6 months, yes or no) using univariate and multivariate analysis.
A total of 558 patients were included (249 men, 300 women, mean age 68.4 years, mean disease duration 4.9 years). The surgeon's decision, available for 486 patients, was to prescribe THA in 60.7% of patients. On multivariate analysis, the variables related to the surgeon's decision were the presence or absence of severe cardiovascular disease, Short Form 12 physical subscale score, and amount of joint space narrowing.
While the amount of structural degradation is only slightly or not at all taken into account in numerous criteria and/or recommendations on indications for THA, it is an independent predictor of the surgeon's decision in daily practice. Such a discrepancy should be evaluated and understood in further studies.