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Can we accurately predict outcome after hip and knee replacement?

Hip and knee replacement rates are rising rapidly. In light of the tremendous socioeconomic impact of joint replacement surgery, it is important to understand which surgical, implant and patient-specific factors influence outcome to develop appropriate care protocols and maximize clinical outcomes. Our understanding of and ability to predict outcome is dependent on the validity of the tools we use; thus, understanding the limitations of our current instruments is critical in interpreting the results of outcome studies. This paper presents an overview of the most commonly used hip and knee replacement outcome assessment tools. We reviewed studies of validity, reliability and responsiveness. In particular, we explained how the limitations of our outcome instruments affect our knowledge of joint replacement outcome. In the absence of a “gold standard” instrument, combining a performance-based measure with a patient-assessed quality of life instrument and a clinician-assessed joint specific tool is likely the most accurate method to assess joint replacement outcome.