Skip Navigation


Rheumatology Advance Access originally published online on September 2, 2009
Rheumatology 2009 48(11):1402-1409; doi:10.1093/rheumatology/kep264
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplementary Data
Right arrow All Versions of this Article:
48/11/1402    most recent
kep264v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Quintana, J. M.
Right arrow Articles by Goenaga, J. I.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Quintana, J. M.
Right arrow Articles by Goenaga, J. I.
Related Collections
Right arrow Osteoarthritis and Cartilage
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Decision trees for indication of total hip replacement on patients with osteoarthritis

José M. Quintana1, Amaia Bilbao2, Antonio Escobar3, Jesus Azkarate4 and Jose I. Goenaga5

1Unidad de Investigación, Hospital de Galdakao – CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, 2Fundación Vasca de Innovación e Investigación Sanitarias (BIOEF) – CIBER Epidemiología y Salud Pública (CIBERESP), Sondika, 3Unidad de Investigación, Hospital de Basurto – CIBER Epidemiología y Salud Pública (CIBERESP), Bilbao, 4Servicio de Traumatología, Hospital de Mendaro, Mendaro, Guipuzkoa and 5Servicio de Traumatología, Hospital de Santiago, Vitoria, Alava, Spain.

Correspondence to: José M. Quintana, Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya, Spain. E-mail: josemaria.quintanalopez{at}osakidetza.net


  Abstract

Objective. To develop a decision tree based on health-related quality of life outcomes rather than expert consensus for determining the appropriateness of total hip replacement (THR) among patients with hip OA.

Methods. This is a prospective observational study of two independent cohorts. The derivation cohort included 590 patients recruited from seven hospitals between March 1999 and March 2000. The validation cohort included 339 patients recruited from six hospitals between September 2003 and September 2004. Socio-demographic and clinical data were collected for the participants, all of whom completed the WOMAC before hip replacement and 6 months later. Univariate and Regression Trees, by classification and regression trees (CART), analyses were performed in the derivation cohort. The decision trees derived in the derivation cohort were validated in the validation cohort.

Results. Main variables that predicted change in the WOMAC pain and functional limitation domains were pre-intervention pain or functional limitation and the application of non-surgical treatments. CART analysis showed that when pre-intervention pain was classified as minor, or WOMAC pain or functional limitation scores were <=40, there was an odds ratio of 0.076 (95% CI 0.031, 0.185) of having an expected gain after THR in the WOMAC pain domain of >30 or >25 in the WOMAC functional limitation domain.

Conclusions. A simple decision tree based on WOMAC outcomes can help to determine the appropriate application of THR. It could also be used to evaluate clinical practice or for quality control.

KEY WORDS: Hip osteoarthritis, Hip replacement, Quality of life, Appropriateness, Decision trees

Submitted 6 April 2009; revised version accepted 23 July 2009.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.