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Improving patient reported outcomes in total hip replacement and total knee replacement: What can we learn from the “best” and the “poorest” performing sites?

Thomas W Wainwright, Kieran Gallagher, Athanasios Polllalis, Tikki Immins, Robert G Middleton


Introduction: Oxford Hip Scores (OHS) and Oxford Knee Scores (OKS) are being collected as part of the Patient Reported Outcome Measures (PROMs) evaluation programme on total hip and knee replacement. This study compares the PROMs outcomes from best and poorest performing English hospitals, as defined by NHS England’s data of elective hip and knee surgery. This was to quantify the difference and identify the scope for improvement.

Materials and Methods: OHS and OKS were obtained from the Health and Social Care Information Centre for April 2013 to March 2014.

Results: Seven sites for OHS and 10 sites for OKS were above the upper 95% control limit. Fourteen sites for OHS and 10 sites for OKS were below the lower 95% control limit. Median pre-operative scores were similar between best and poorest performers. Median post-operative scores were 4 points higher in best performers. Top OHS-performers scored better in limping, stairs, work, transport, dressing and shopping. Top OKS-performers scored better in walking, shopping and kneeling.

Discussion: Pre-operative scores were similar for the best and poorest performers. The differences between best  and poorest performing hospitals for OHS and OKS were below the minimum important difference. There was only moderate consistency for outliers. Results for any single year should be treated with caution.

Conclusions: PROMs, one of many key tools in measuring and increasing person-centered healthcare, can be useful as part of an evaluation of practice but do not always reveal the full picture. It is important that balanced measures of quality should be used when benchmarking hospitals.


Activities of daily living (ADLs), arthroplasty, case-mix, co-morbidity, efficiency targets, Oxford Hip Score, Oxford Knee Score, patient experience, patient reported outcome measures (PROMs), performance management, person-centered healthcare, person-cen

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