OUTCOME SCORES

Outcome Scores

In an ideal world it would be appropriate to follow-up all major joint replacement procedures for life (like MOT for our cars). However, it takes significant resources from the health system including the cost, number of man hours as well the inconvenience faced by the patients in making their follow-up trips when they are completely asymptomatic.

But at the same time, if the patients are not followed up regularly, silent problems like implant loosening, impending peri-prosthetic fracture etc., may not be picked up early and when they become symptomatic, the bone loss may be severe requiring more complex surgery. To avoid such a situation some form of follow-up is required.

Studies have shown that if after the initial year or two, the patients could be followed up by validated outcome score questionnaires and radiological investigations at appropriate time intervals which could be reviewed by their surgeons without having to see the patients personally in the clinics. Patients could be called back for review if problems are identified. Hopefully this system of follow-up will also be adopted in our part of the world in the near future! It is likely that you may be enquired by your patients about these outcome measures.

Oxford Hip score and Oxford Knee score are two of the commonly used patient reported outcome scores – they are simple to use and have been validated. However, in young and active patients the scoring systems reach a ceiling effect (i.e. most of the patients score very well but it does not differentiate “very good” from “good”). Most of the scoring systems give predominance to pain relief and less importance to activity levels which many of the young and active patients consider important to regain in addition to the pain relief following a joint replacement. UCLA score is a validated scoring system for hip replacement outcome in younger adults as the Oxford hip scores probably reach a ceiling effect in many younger patients.

In addition you could also ask the patients to do the Oxford Hip/Knee scores when they see you for hip or knee arthritis and although there is no cut off score which indicate that a surgical treatment is warranted, the scores will give you a guide to the severity of the patient’s problem and also an objective data tool to justify your referral for example to seek an urgent orthopaedic appointment for your patient (and it is also more than likely that the orthopaedic surgeons will be caught by surprise if your patients bring the Oxford scores to the clinic along with their prescription!).

The non arthritic hip score is used to evaluate non arthritic hip problems like hip impingement.