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Evaluation by explicit criteria of the use of total hip joint replacement.

OBJECTIVE
To evaluate the appropriateness of the use of total hip replacement (THR) using explicit criteria developed by an expert panel.


METHODS
Patients with a diagnosis of osteoarthritis who were undergoing THR in five public hospitals in Spain were included consecutively in the study during a 1-yr period. The appropriateness of the indication was judged by explicit criteria developed using a mutidisciplinary approach. Complications were measured 3 months after surgery. One year after discharge, pain, functional limitation and general health were measured.


RESULTS
After evaluation of 583 patients, 82 (13.6%) were considered to have undergone inappropriate procedures, and for 279 (46.2%) patients indication for the procedure was considered uncertain. Differences were found in the rate of appropriateness among some centres. One year after discharge, the perception of general health was slightly better in those patients who had been judged to have undergone an appropriate procedure.


CONCLUSIONS
The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure.