title: Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection?
abstract: We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question.  Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman's rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care.
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Judge
authors.forename: N K
authors.initials: NK
authors.lastname: Arden
authors.forename: A
authors.initials: A
authors.lastname: Price
authors.forename: S
authors.initials: S
authors.lastname: Glyn-Jones
authors.forename: D
authors.initials: D
authors.lastname: Beard
authors.forename: A J
authors.initials: AJ
authors.lastname: Carr
authors.forename: J
authors.initials: J
authors.lastname: Dawson
authors.forename: R
authors.initials: R
authors.lastname: Fitzpatrick
authors.forename: R E
authors.initials: RE
authors.lastname: Field
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013222:State Medicine; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom