NHS figures published in 2020 show that there were 81,130 hip replacements in the year from April 2018 to March 2019. The majority (59.4%) were carried out on female patients. Over the same time period, there were 93,911 knee replacements. Again, more than half of these (56.5%) were on female patients.
Patient reported outcome measures
Patient Reported Outcome Measures (PROMS) are a way of assessing how satisfied patients are with the results of their surgery. By asking patients questions such as “Overall, how are the problems now compared to before your operation?” and “How would you describe the results of your operation?” success rates can be measured.
According to NHS Digital, 86.6% of hip replacement patients reported feeling “much better” than before their operation.
For knee replacement patients, 75% said they felt “much better”.
When asked to evaluate the results of their surgery, 44.4% of hip replacement patients described the results as “excellent” and 33.8% as “very good”. Satisfaction levels for knee replacement patients were 28.6% “excellent” and 36% “very good”.
Oxford research
As orthopaedic surgeons, we are continually developing new techniques and embracing new technologies with the aim of improving patient outcomes. A recent study by researchers at the University of Oxford set out to discover whether patients undergoing hip and knee replacements have seen improved outcomes over the past seven years.
The researchers looked at NHS patient reported outcome measures for people who’d had a primary hip replacement or primary knee replacement. (Primary simply means it was the first time that joint had been replaced. Over time, artificial joints start to wear and need to be replaced. This is called a revision joint replacement).
Methodology
The research team carried out secondary data analysis for 277,430 hip replacements and 308,007 knee replacements from the NHS PROMS programme. They compared outcome measures based on the year of surgery using multiple linear and logistic regression models. The measures they looked at were:
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- Post-operative Oxford Hip/Knee Score. This is a patient-reported outcome measure that was developed to assess levels of disability, pain and function. It was originally developed in 1996 and updated in 2007.
- Patients reporting a clinically-important improvement in joint function.
- Quality of life.
- Patient satisfaction.
- Perceived success.
- Any complications.
Findings
The study concluded that nearly all patient-reported outcomes have improved over the last seven years for both hip replacements and knee replacements. In the case of hip replacements, more recent surgery was associated with higher post-operative Oxford Hip Scores. Patient satisfaction levels also rose in later years and the risks of complications diminished, although there was no discernible trend regarding perceived success of the surgery.
For patients undergoing a total knee replacement, it was a similar picture. More recent years of surgery were associated with higher post-operative Oxford Knee Scores. Patient satisfaction levels and perceived success all increased with year of surgery, while the odds of complications fell.
Overall, this appears to be good news for patients as it shows an upward trend in positive outcomes and a downward trend in the possibility of developing complications. Researchers suggest that in the coming years, it may be necessary to drill down further into these patient-reported outcome measures due to the high proportion of patients achieving good outcomes. Without this it might be difficult to continue measuring improvements in outcomes.
Life-changing surgery
However, what this research shows is that joint replacement surgery can be life-changing for patients with severe hip and knee pain, helping to relieve pain, improve mobility and enhance quality of life.
Severe joint pain is most often caused by a degenerative disease like osteoarthritis, which is linked to ageing, however it can also be linked to other conditions such as rheumatoid arthritis, gout or joint deformity.
If you are interested in a diagnosis or discussing the range of treatment options for hip or knee pain, please contact us.
