Development and Validation of Crosswalks Between the Western Ontario & McMaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score Joint Replacement/Knee Injury and Osteoarthritis Outcome Score Joint Replacement.

Abstract

The wide variety of patient-reported outcome measures used to assess outcomes following total joint arthroplasty can present a substantial methodological obstacle when attempting to compare information across studies or between institutions. A simple solution is to create crosswalks that reliably convert scores between patient-reported outcome measures. Our goal is to create and validate crosswalks between the commonly used Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and short-form versions of the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR)/Knee Injury and Osteoarthritis Outcome Score (KOOS JR.). Patients in our joint replacement registry were included if they underwent primary total hip arthroplasty (n = 4649) or total knee arthroplasty (n = 3750) for osteoarthritis between May 2007 and February 2012. We used their preoperative and 2-year postoperative HOOS scores (n = 6351) or KOOS scores (n = 4688) to generate the patients' WOMAC and HOOS JR/KOOS JR scores. The equipercentile equating method was applied to create 10 crosswalks: HOOS JR/KOOS JR to WOMAC Total (WOMAC-T), and WOMAC-T, WOMAC Pain (WOMAC-P), WOMAC Stiffness (WOMAC-S), and WOMAC Function (WOMAC-F) to HOOS JR/KOOS JR. Crosswalk validity was assessed by comparing actual and derived scores using Spearman's rank correlation coefficients in a bootstrapped cohort. All 10 crosswalks showed strong positive correlations ranging from 0.846 (WOMAC-S to KOOS JR) to 0.981 (HOOS JR to WOMAC-T). We created and validated 10 crosswalks between WOMAC and HOOS JR/KOOS JR. We recommend using the crosswalks between WOMAC-T and HOOS JR/KOOS JR when possible, as they demonstrated the highest correlation. WOMAC-F or WOMAC-P should be used in favor of WOMAC-S if only subscores are available. The HOOS JR/KOOS JR should only be converted to a WOMAC-T. Level III.