In the Journals

Most patients experience symptoms for 1-5 years prior to hip replacement

Between 2009 and 2016, nearly 70% of patients experienced symptoms for 1 to 5 years while they waited for hip replacement surgery, with longer durations significantly predictive of poorer post-surgery outcomes, according to data published in Arthritis Care & Research.

“There is evidence that a longer formal waiting time between the decision to operate by a surgeon and the surgery date is associated with poorer outcomes after surgery,” YiuShing Lau, PhD, of the University of Manchester in England, and colleagues wrote. “Typically, however, symptom duration is a much longer period than waiting time. Waiting time only covers the period between a patient being deemed appropriate and ready for surgery and the date of surgery, whereas symptom duration includes the time periods when patients are not yet ready, as well as the waiting time when they are ready.”

The researchers added: “The relationship between symptom duration and outcomes is unclear, and it is unknown whether variations in symptom duration reflect variation in the rates and timing of [total hip arthroplasty], or whether symptom duration has become more standardized with better evidence and more guidelines.”

To evaluate the impact of symptom duration on pre- and post-surgical outcomes, Lau and colleagues collected national observational data on patient-reported outcome measures from the National Health Service in England between 2009 and 2016. Specifically, the researchers reviewed exposure and symptom duration data from the preoperative patient-reported outcomes (PROMs) questionnaire completed by patients who underwent total hip arthroplasty.

This information was then linked to administrative data from Hospital Episode Statistics, which contains detailed clinical and demographic information on all inpatient admissions funded by the NHS.

Of the 320,474 patients who received total hip arthroplasty and completed a PROMs questionnaire, the researchers included 209,192 in the final dataset. This included patients who completed both the pre- and post-operative questionnaire, those without congenital conditions or a previously similar surgery, those older 50 years and those without previous hip fracture.

According to the researchers, 69% of the included patients experienced symptoms for 1 to 5 years prior to total hip arthroplasty. Of the remaining patients, 14% experienced symptoms for less than 1 year, 11% had symptoms for 6 to 10 years and 5% experienced symptoms for more than 10 years. Overall symptom duration decreased throughout the study period, but was shorter in men, as well as those who were older and less deprived.

In addition, patients with symptom durations of less than 1 year demonstrated better postsurgical pain and function (Oxford Hip Score = 0.875; 95% CI, 0.777-0.973) compared with those with 1 to 5 years symptom duration. Patients with symptom duration exceeding 5 years experienced worse postsurgical outcomes.

“This study found patients experiencing longer symptom duration to report poorer health prior to surgery and lower health gains from surgery,” Lau and colleagues wrote. “Although the treatment pathway from symptom onset to [total hip arthroplasty] is complex and causes of delays are multifactorial, interventions that minimize unnecessary delays to surgery that further extend symptom duration, such as inappropriate care or ineffective referral and triage processes, have the potential to improve patient outcomes.” – by Jason Laday

Disclosure: Lau reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

Between 2009 and 2016, nearly 70% of patients experienced symptoms for 1 to 5 years while they waited for hip replacement surgery, with longer durations significantly predictive of poorer post-surgery outcomes, according to data published in Arthritis Care & Research.

“There is evidence that a longer formal waiting time between the decision to operate by a surgeon and the surgery date is associated with poorer outcomes after surgery,” YiuShing Lau, PhD, of the University of Manchester in England, and colleagues wrote. “Typically, however, symptom duration is a much longer period than waiting time. Waiting time only covers the period between a patient being deemed appropriate and ready for surgery and the date of surgery, whereas symptom duration includes the time periods when patients are not yet ready, as well as the waiting time when they are ready.”

The researchers added: “The relationship between symptom duration and outcomes is unclear, and it is unknown whether variations in symptom duration reflect variation in the rates and timing of [total hip arthroplasty], or whether symptom duration has become more standardized with better evidence and more guidelines.”

To evaluate the impact of symptom duration on pre- and post-surgical outcomes, Lau and colleagues collected national observational data on patient-reported outcome measures from the National Health Service in England between 2009 and 2016. Specifically, the researchers reviewed exposure and symptom duration data from the preoperative patient-reported outcomes (PROMs) questionnaire completed by patients who underwent total hip arthroplasty.

This information was then linked to administrative data from Hospital Episode Statistics, which contains detailed clinical and demographic information on all inpatient admissions funded by the NHS.

Of the 320,474 patients who received total hip arthroplasty and completed a PROMs questionnaire, the researchers included 209,192 in the final dataset. This included patients who completed both the pre- and post-operative questionnaire, those without congenital conditions or a previously similar surgery, those older 50 years and those without previous hip fracture.

According to the researchers, 69% of the included patients experienced symptoms for 1 to 5 years prior to total hip arthroplasty. Of the remaining patients, 14% experienced symptoms for less than 1 year, 11% had symptoms for 6 to 10 years and 5% experienced symptoms for more than 10 years. Overall symptom duration decreased throughout the study period, but was shorter in men, as well as those who were older and less deprived.

In addition, patients with symptom durations of less than 1 year demonstrated better postsurgical pain and function (Oxford Hip Score = 0.875; 95% CI, 0.777-0.973) compared with those with 1 to 5 years symptom duration. Patients with symptom duration exceeding 5 years experienced worse postsurgical outcomes.

“This study found patients experiencing longer symptom duration to report poorer health prior to surgery and lower health gains from surgery,” Lau and colleagues wrote. “Although the treatment pathway from symptom onset to [total hip arthroplasty] is complex and causes of delays are multifactorial, interventions that minimize unnecessary delays to surgery that further extend symptom duration, such as inappropriate care or ineffective referral and triage processes, have the potential to improve patient outcomes.” – by Jason Laday

Disclosure: Lau reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.