Oxford hip and knee scores deteriorate in patients awaiting lower limb arthroplasty during the COVID-19 pandemic and predict a health state 'worse than death'

Jack O Clark; Nima Razii; S W Justin Lee; Stephen J Grant; Martin J Davison; Oliver Bailey

doi:10.1302/2633-1462.43.BJO-2022-0136.R1

Oxford hip and knee scores deteriorate in patients awaiting lower limb arthroplasty during the COVID-19 pandemic and predict a health state 'worse than death'

Bone Jt Open. 2023 Mar 1;4(3):138-145. doi: 10.1302/2633-1462.43.BJO-2022-0136.R1.

Authors

Jack O Clark¹, Nima Razii², S W Justin Lee², Stephen J Grant³, Martin J Davison¹, Oliver Bailey¹

Affiliations

¹ Department of Trauma and Orthopaedics, University Hospital Wishaw, Lanarkshire, UK.
² Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK.
³ Department of Trauma and Orthopaedics, University Hospital Hairmyres, Glasgow, UK.

PMID: 37051855
PMCID: PMC10032236
DOI: 10.1302/2633-1462.43.BJO-2022-0136.R1

Abstract

The COVID-19 pandemic has caused unprecedented disruption to elective orthopaedic services. The primary objective of this study was to examine changes in functional scores in patients awaiting total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). Secondary objectives were to investigate differences between these groups and identify those in a health state 'worse than death' (WTD). In this prospective cohort study, preoperative Oxford hip and knee scores (OHS/OKS) were recorded for patients added to a waiting list for THA, TKA, or UKA, during the initial eight months of the COVID-19 pandemic, and repeated at 14 months into the pandemic (mean interval nine months (SD 2.84)). EuroQoL five-dimension five-level health questionnaire (EQ-5D-5L) index scores were also calculated at this point in time, with a negative score representing a state WTD. OHS/OKS were analyzed over time and in relation to the EQ-5D-5L. A total of 174 patients (58 THA, 74 TKA, 42 UKA) were eligible, after 27 were excluded (one died, seven underwent surgery, 19 non-responders). The overall mean OHS/OKS deteriorated from 15.43 (SD 6.92), when patients were added to the waiting list, to 11.77 (SD 6.45) during the pandemic (p < 0.001). There were significantly worse EQ-5D-5L index scores in the THA group (p = 0.005), with 22 of these patients (38%) in a health state WTD, than either the TKA group (20 patients; 27% WTD), or the UKA group (nine patients; 21% WTD). A strong positive correlation between the EQ-5D-5L index score and OHS/OKS was observed (r = 0.818; p < 0.001). Receiver operating characteristic analysis revealed that an OHS/OKS lower than nine predicted a health state WTD (88% sensitivity and 73% specificity). OHS/OKS deteriorated significantly among patients awaiting lower limb arthroplasty during the COVID-19 pandemic. Overall, 51 patients were in a health state WTD, representing 29% of our entire cohort, which is considerably worse than existing pre-pandemic data.