Abstract
There is no consensus regarding indications for total hip arthroplasty (THA) in hip osteoarthritis (OA). Patients can be referred to surgeons either by a general practitioner (GP) or a rheumatologist. The aim of this study was to determine whether patients referred to orthopedic surgeons by GP and rheumatologists differed. GPs and rheumatologists were asked to include one patient suffering from hip OA for whom a consultation with a surgeon was planned to determine if THA was indicated. Surgeons’ decisions were obtained by follow-up questionnaires. Univariate and then multivariate statistical analysis evaluated differences between patients referred by GPs and those referred by rheumatologists. A total of 558 patients were included. THA was prescribed in 71.6 % of patients referred by rheumatologists vs. 57.6 % of patients referred by GPs (p = 0.008). Patients referred by rheumatologists were younger (66.3 vs. 69.3 years; p = 0.006), less frequently retired (72.9 vs. 84.2 %; p = 0.007), and presented with a higher New Zealand score (54.3 vs. 48.1; p = 0.0009). On multivariate analysis, the variables related to patients referred by rheumatologists were the SF-12 mental score, the New Zealand score, and the surgeon’s decision. Patients consulting a surgeon to discuss THA were more likely to be operated on when referred by a rheumatologist, which might be due to differences in the rheumatologists’ and GPs’ opinions on the right time to perform surgery or due to differences in the populations followed by rheumatologists and GPs, those followed by rheumatologists being younger, more active, more urban, with a greater willingness to undergo surgery.
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References
McAlindon TE, Cooper C, Kirwan JR, Dieppe PA (1993) Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 52(4):258–262
Felson DT, Radin EL (1994) What causes knee osteoarthrosis: are different compartments susceptible to different risk factors? J Rheumatol 21(2):181–183
Merx H, Dreinhofer K, Schrader P, Sturmer T, Puhl W, Gunther KP, Brenner H (2003) International variation in hip replacement rates. Ann Rheum Dis 62(3):222–226
Peterson MG, Hollenberg JP, Szatrowski TP, Johanson NA, Mancuso CA, Charlson ME (1992) Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States. J Bone Joint Surg Br 74(10):1530–1539
Charlson ME, Allegrante JP (2000) Disparities in the use of total joint arthroplasty. N Engl J Med 342(14):1044–1045
Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342(14):1016–1022
Hawker GA, Wright JG, Glazier RH, Coyte PC, Harvey B, Williams JI, Badley EM (2002) The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum 46(12):3331–3339
Brand C, Osborne R, Landgren F, Morgan M (2007) Referral for Joint Replacement: a management guide for health providers. RACGP, South Melbourne
Crawford RW, Murray DW (1997) Total hip replacement: indications for surgery and risk factors for failure. Ann Rheum Dis 56(8):455–457
Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN (1999) Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 42(8):1722–1728
Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN (2002) Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 46(12):3327–3330
Holtzman J, Saleh K, Kane R (2002) Effect of baseline functional status and pain on outcomes of total hip arthroplasty. J Bone Joint Surg Br 84-A(11):1942–1948
Mancuso CA, Ranawat CS, Esdaile JM, Johanson NA, Charlson ME (1996) Indications for total hip and total knee arthroplasties. Results of orthopaedic surveys. J Arthroplast 11(1):34–46
Dreinhofer KE, Dieppe P, Sturmer T, Grober-Gratz D, Floren M, Gunther KP, Puhl W, Brenner H (2006) Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians. Ann Rheum Dis 65(10):1346–1350
Maillefert JF, Roy C, Cadet C, Nizard R, Berdah L, Ravaud P (2008) Factors influencing surgeons’ decisions in the indication for total joint replacement in hip osteoarthritis in real life. Arthritis Rheum 59(2):255–262
Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34(5):505–514
Hosmer DLS (2000) Applied logistic regression, 2nd edn. Wiley, New York
Sturmer T, Dreinhofer K, Grober-Gratz D, Brenner H, Dieppe P, Puhl W, Gunther KP (2005) Differences in the views of orthopaedic surgeons and referring practitioners on the determinants of outcome after total hip replacement. J Bone Joint Surg Br 87(10):1416–1419
Rahman MM, Kopec JA, Sayre EC, Greidanus NV, Aghajanian J, Anis AH, Cibere J, Jordan JM, Badley EM (2011) Effect of sociodemographic factors on surgical consultations and hip or knee replacements among patients with osteoarthritis in British Columbia, Canada. J Rheumatol 38(3):503–509
Judge A, Welton NJ, Sandhu J, Ben-Shlomo Y (2010) Equity in access to total joint replacement of the hip and knee in England: cross sectional study. BMJ 341:c4092
Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis 62(10):923–930
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This study was supported by NEGMA-LERADS laboratories.
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Samson, M., Maillefert, JF., Roy, C. et al. Do hip OA patients referred to orthopedic surgeons by general practitioners and rheumatologists differ?. Clin Rheumatol 31, 1301–1307 (2012). https://doi.org/10.1007/s10067-012-2006-4
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DOI: https://doi.org/10.1007/s10067-012-2006-4