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dc.contributor.authorWalker, R. W.
dc.contributor.authorWhitehouse, S. L.
dc.contributor.authorHowell, J. R.
dc.contributor.authorHubble, M. J. W.
dc.contributor.authorTimperley, A. J.
dc.contributor.authorWilson, M. J.
dc.contributor.authorKassam, A. M.
dc.date.accessioned2022-04-21T09:41:51Z
dc.date.available2022-04-21T09:41:51Z
dc.date.issued2022-03-01
dc.identifier.citationBone Jt Open. 2022 Mar;3(3):196-204. doi: 10.1302/2633-1462.33.BJO-2021-0204.R1.
dc.identifier.pmid35253478
dc.identifier.doi10.1302/2633-1462.33.Bjo-2021-0204.R1
dc.identifier.urihttps://rde.dspace-express.com/handle/11287/622469
dc.description.abstractAIMS: The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients' access to THA and outcomes. METHODS: Patients undergoing primary THA at our institution with an OHS both preoperatively and at least four years postoperatively were included. Rationing thresholds were explored to identify possible deprivation of OHS improvement. RESULTS: Overall, 2,341 patients were included. Mean OHS was 19.7 (SD 8.2) preoperatively and 39.7 (SD 9.8) at latest follow-up. An improvement of at least eight-points, the minimally important change (MIC), was seen in 2,072 patients (88.5%). The mean improvement was 20.0 points (SD 10.5). If a rationing threshold of OHS of 20 points had been enforced, 90.8% of those treated would have achieved the MIC, but only 54.3% of our cohort would have had access to surgery; increasing this threshold to 32 would have enabled 89.5% of those treated to achieve the MIC while only depriving 6.5% of our cohort. The 'rationed' group of OHS > 20 had significantly better OHS at latest follow-up (42.6 vs 37.3; p < 0.001), while extending the rationing threshold above 32 showed postoperative scores were more significantly affected by the ceiling effect of the OHS. CONCLUSION: The OHS was not designed as a tool to ration healthcare, but if it had been used at our institution for this cohort, applying an OHS threshold of 20 to routine THA access would have excluded nearly half of patients from having a THA; a group in which over 85% had a significant improvement in OHS. Where its use for rationing is deemed necessary, use of a higher threshold may be more appropriate to ensure a better balance between patient access to treatment and chances of achieving good to excellent outcomes. Cite this article: Bone Jt Open 2022;3(3):196-204.
dc.language.isoeng
dc.publisherBritish Editorial Society of Bone and Joint Surgery
dc.relation.urlhttps://online.boneandjoint.org.uk/doi/10.1302/2633-1462.33.BJO-2021-0204.R1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
dc.rights© 2022 Author(s) et al
dc.rights.urihttp://creativecommons.org/publicdomain/zero/1.0/
dc.subjectCOVID-19 pandemic
dc.subjectOxford Hip Score
dc.subjectOxford Hip Score (OHS)
dc.subjectTotal hip arthroplasty (THA)
dc.subjectarthroplasty
dc.subjectarthroplasty surgery
dc.subjecthip
dc.subjecthips
dc.subjectknee arthroplasty
dc.subjectoutcomes
dc.subjectpatient-reported outcome measures (PROMs)
dc.subjectprimary THAs
dc.subjectrationing
dc.subjectrevision surgery
dc.subjectstandard deviation
dc.subjectthreshold
dc.titleIs rationing of total hip arthroplasty justified? Working to optimize patient accessibility to surgery using long-term patient-reported outcome data
dc.typeJournal Article
dc.identifier.journalBone & joint open
dc.description.noteThe article is available via Open Access. Click on the 'Additional link' above to access the full-text.
dc.type.versionppublish
dc.description.admin-notePublished version
dc.date.epub2022-03-08
dc.citation.volume3
dc.citation.issue3
dc.citation.spage196-204


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