Outcome instruments in hip hemiarthroplasty research trials

Issue: BCMJ, vol. 59, No. 10, December 2017, Pages 495-496 Letters
By: Rajesh Nair, MD

Hip fractures are common injuries among the elderly, often requiring some form of surgical intervention.

Hip fractures are common injuries among the elderly, often requiring some form of surgical intervention.[1,2] Hemiarthroplasty is a good choice for older, less-active patients without extensive arthritis compared to total hip arthroplasty (THA) due to the shorter surgical times and reduced complication rates.[1,2] Typically, outcome assessments have focused on mortality, implant revisions, or intraoperative complications, and less on patient-centred outcomes.[3] However, the growing shift away from such conventional metrics has resulted in a renewed focus on patient-reported outcome measures (PROMs). What is the current evidence for using PROMs in hemiarthroplasty trials?

To justify using PROMs we have to consider their reliability, responsiveness, and validity. Practicality (ease of use, cost of implementation, and clinical interpretability of scores) must also be assessed. Two studies available in PubMed assess the psychometric properties of EuroQol-5D (EQ-5D), Barthel index, Harris hip score, and short-form musculoskeletal function assessment.[1,2] Three articles and a systematic review have assessed the use and availability of PROMs following hip fractures in patients treated with either hemiarthroplasty or THA.[3-6] The common themes are lack of a standardized approach to outcome reporting, routine use of tools derived for THA patients, and paucity of vigorous PROM appraisal exclusively for hemiarthroplasty patients. The dearth of studies evaluating PROMs for outcome instruments in hip hemiarthroplasty research trials prevents any clear recommendations. Further research must focus on identifying valid instruments that can be routinely used in clinical practice.
—Rajesh Nair, MD
Clinical Research Fellow, Vancouver Island Health Authority
Victoria

References

1. Frihagen F, Grotle M, Madsen JE, et al. Outcome after femoral neck fractures: A comparison of Harris Hip Score, Eq-5d, and Barthel Index. Injury 2008;39:1147-1156. 

2. Hedbeck CJ, Tidermark J, Ponzer S, et al. Responsiveness of the short musculoskeletal function assessment (SMFA) in patients with femoral neck fractures. Qual Life Res 2011;20:513-521.

3. Haywood KL, Brett J, Tutton E, Staniszewska S. Patient-reported outcome measures in older people with hip fracture: A systematic review of quality and acceptability. Qual Life Res 2017;26:799-812.

4. Ahmad MA, Xypnitos FN, Giannoudis PV. Measuring hip outcomes: Common scales and checklists. Injury 2011;42:259-264. 

5. Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: How are we measuring outcome? Injury 2011;42:1205-1213. 

6. Bryant DM, Sanders DW, Coles CP, et al. Selection of outcome measures for patients with hip fracture. J Orthop Trauma 2009;23:434-441.

Rajesh Nair, MD. Outcome instruments in hip hemiarthroplasty research trials. BCMJ, Vol. 59, No. 10, December, 2017, Page(s) 495-496 - Letters.


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