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Responsiveness of the EQ-5D-3L and EQ-5D-5L in patients following total hip or knee replacement



To examine the responsiveness of the EQ-5D-3L and EQ-5D-5L among total hip/knee replacement (THR/TKR) patients.


The EQ-5D (3L or 5L) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) have been routinely administered to all THR/TKR patients before and at 3 months after surgery in Alberta, Canada, since 2010. Patients were included in this analysis if they completed the WOMAC and the same version of EQ-5D at baseline and 3-month follow-up. The WOMAC was used as an anchor to categorize patients into 9 subgroups according to the relative change from baseline, i.e., no change, and 4 categories each for the amount of deterioration or improvement: large (≥ 70%), moderate (50% ≤ change < 70%), small but important (20% ≤ change < 50%), and very mild (0 < change ≤ 20%). The responsiveness of the EQ-5D-3L and EQ-5D-5L for each subgroup was assessed using effect size, standardized response mean, and Guyatt’s Responsiveness Index.


A total of 1594 patients completed the EQ-5D-3L and WOMAC (60% females, mean age 66 years, N = 646 [41%] THR), and 3180 completed the EQ-5D-5L and WOMAC (60% females, mean age 66 years, N = 1352 [43.2%] THR) at baseline and 3-month follow-up. For both THR and TKR patients with “small but important” improvement, the EQ-5D-5L was consistently more responsive than the EQ-5D-3L.


Our study demonstrated that the EQ-5D-5L is more responsive than the EQ-5D-3L in identifying health-related quality of life changes in THR/TKR patients. We recommend using the EQ-5D-5L in longitudinal studies in this patient population.

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We thank EuroQol Research Foundation for supporting this study.

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Correspondence to Jeffrey A. Johnson.

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The authors declare that they have no conflict of interest.

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The data used in this analysis was collected as part of standard of care, and not part of a clinical study. As such, it was captured under the authority of the provincial Privacy Impact Analysis in place for quality assurance monitoring and reporting on Bone and Joint Health in Alberta (OIPC File # H2801). Participants do not provide consent.

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Jin, X., Al Sayah, F., Ohinmaa, A. et al. Responsiveness of the EQ-5D-3L and EQ-5D-5L in patients following total hip or knee replacement. Qual Life Res 28, 2409–2417 (2019). https://doi.org/10.1007/s11136-019-02200-1

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  • EQ-5D
  • Responsiveness
  • Measurement properties
  • Total hip replacement
  • Total knee replacement