INTRODUCTION

Can the WOMAC score be used to predict patient satisfaction following hip replacement?
An Analysis of patient-reported outcomes for joint replacement

METHODS RESULTS

BA Rogers, AD Carrothers, HJ Kreder, R Jenkinson & Safe T Study Group

DISCUSSION

INTRODUCTION
Greater attention on PROMS in orthopaedic surgery Ie Oxford Scores Western Ontario and McMaster Universities (WOMAC)

INTRODUCTION METHODS

Now used for Selection of patients suitable for surgery Outcome of surgery Quality of surgeon
WOMAC & Oxford scores introduced for clinical trials not specifically for PROMS

RESULTS DISCUSSION

INTRODUCTION

INTRODUCTION METHODS RESULTS

Is the same true for WOMAC score?.....

DISCUSSION

AIM

INTRODUCTION

To what degree can pre-operative

METHODS

WOMAC can be used to predict

satisfaction following joint

replacement?
RESULTS DISCUSSION

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

INTRODUCTION METHODS RESULTS

primary THA Standardized post-op rehabilitation protocol Independent Data Collection Pre-operative & one year post THA

DISCUSSION

METHODS
Scatter-plot Rank Spearman does correlation exist? A receiver operating characteristic (ROC) curve analysis identify if there is a cut-off point for pre-operative WOMAC delta WOMAC

INTRODUCTION METHODS RESULTS

...that predicts post-op patient satisfaction?

DISCUSSION

PRE-OP DEMOGRAPHICS RESULTS

INTRODUCTION

Study N=460 Mean age surgery 62.7 years (range: 25-80) Mean BMI 29.5

METHODS RESULTS DISCUSSION

INTRODUCTION

METHODS RESULTS DISCUSSION

SURGICAL DATA

INTRODUCTION

THA Bearing Combinations (%)

0.2 0.2 metal-on-polyethylene ceramic-on-polyethylene metal-on-metal ceramic-on-ceramic metal-on-ceramic

METHODS

8
8

RESULTS

84
DISCUSSION

INTRODUCTION

WOMAC Pre-Op Mean SD 51 (2 94) 17

Satisfaction

21 (6-25) 3
METHODS

Post-Op
Mean SD Delta Mean SD 38 (2 22) 3 1 (0 1) 1 13 (0 72) 15 22 (5 25) 4

RESULTS DISCUSSION

RESULTS
100 90 80

INTRODUCTION

R = 0.0065
METHODS

Baseline WOMAC

70 60 50 40 30

RESULTS

20 10 0

10

15

20

25
DISCUSSION

1 yr satisfaction

RESULTS
100 90 80

INTRODUCTION METHODS

Baseline WOMAC

70 60 50 40 30

R = 0.0041

RESULTS

20 10 0
0 20 40 60 80 100

1 yr WOMAC
DISCUSSION

RESULTS
Pre-Op WOMAC
1

INTRODUCTION METHODS

0.75

Area Under Curve = 0.53

Sensitivity
0.5

RESULTS

0.25

0 0 0.25 0.5 0.75 1

DISCUSSION

1 - Specificity

RESULTS
Delta WOMAC
1

INTRODUCTION

0.75

Area Under Curve = 0.43

METHODS

Sensitivity

0.5

RESULTS

0.25

0 0 0.25 0.5 0.75 1

DISCUSSION

1 - Specificity

DISCUSSION
Scatter plots No correlation ROC analysis Pre-op WOMAC Delta WOMAC near straight line ROC curves

INTRODUCTION METHODS RESULTS

No cut-off in WOMAC score predicts satisfaction

DISCUSSION

RESULTS
1 year WOMAC
1

INTRODUCTION

Area Under Curve = 0.67

METHODS

0.75

Sensitivity

0.5

RESULTS

0.25

0 0 0.25 0.5 0.75 1

DISCUSSION

1 - Specificity

DISCUSSION
One year WOMAC ROC analysis Area under curve 0.67

INTRODUCTION METHODS

which represented sensitivity of 63.9% specificity of 65.9%. Better than pre-op WOMAC but not significant cutoff poor sensitivity & specificity

RESULTS DISCUSSION

DISCUSSION
To what degree can pre-operative WOMAC can be used to predict satisfaction following joint replacement?
In addition Change in WOMAC Post Op WOMAC (!) .No correlation with patient satisfaction after THR

INTRODUCTION METHODS RESULTS DISCUSSION

INTRODUCTION

METHODS RESULTS DISCUSSION

Questions