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An Analysis of patient-reported outcomes for joint replacement
BA Rogers, AD Carrothers, HJ Kreder, R Jenkinson& Safe T Study Group
Can the WOMAC score be used to predict patient satisfaction following hip replacement?
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INTRODUCTION
Greater attention on PROMS in orthopaedic surgery
Ie Oxford ScoresWestern Ontario and McMaster Universities
(WOMAC)
Now used forSelection of patients suitable for surgeryOutcome of surgeryQuality of surgeon
WOMAC & Oxford scoresintroduced for clinical trialsnot specifically for PROMS
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INTRODUCTION
Is the same true for WOMAC score?.....
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AIM
To what degree can pre-operative
WOMAC can be used to predict
satisfaction following joint
replacement?
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METHODS
•SAFET study – commenced 2007 (ongoing)•‘Safe Activities Following Elective THA’•Study design and power calculation
•2 high volume arthroplasty academic centers•Sunnybrook Health Sciences Centre•London Health Sciences Centre
•N=460, prospective consecutive series•primary diagnosis osteoarthritis•≤ 80 years of age and consent capacity
•primary THA •Standardized post-op rehabilitation protocol•Independent Data Collection
•Pre-operative & one year post THA
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METHODS
Scatter-plotRank Spearman
does correlation exist?
A receiver operating characteristic (ROC) curve analysis
identify if there is a cut-off point forpre-operative WOMAC delta WOMAC
...that predicts post-op patient satisfaction?
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PRE-OP DEMOGRAPHICS RESULTS
•Study N=460
•Mean age surgery 62.7 years (range: 25-80)
•Mean BMI 29.5
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SURGICAL DATA
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WOMAC Satisfaction
Pre-Op
Mean 51 (2 – 94) 21 (6-25)
SD 17 3
Post-Op
Mean 13 (0 – 72) 22 (5 – 25)
SD 15 4
Delta
Mean 38 (2 – 22) 1 (0 – 1)
SD 3 1
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RESULTS
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RESULTS
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RESULTS
Area Under Curve = 0.53
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RESULTS
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DISCUSSION
Scatter plots
No correlation
ROC analysis
Pre-op WOMACDelta WOMAC
near straight line ROC curves
No cut-off in WOMAC score predicts satisfaction
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RESULTS
Area Under Curve = 0.67
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One year WOMAC ROC analysis
Area under curve – 0.67
which represented
sensitivity of 63.9%
specificity of 65.9%.
Better than pre-op WOMAC – but not significant cutoff
poor sensitivity & specificity
DISCUSSION
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To what degree can pre-operative WOMAC can be used to predict
satisfaction following joint replacement?
NONE
In additionChange in WOMACPost – Op WOMAC (!)
…….No correlation with patient satisfaction after THR
DISCUSSION
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Questions
