Patient-reported outcome measures for hip and knee arthroplasty in Ontario, Canada.

Abstract

Increasing uptake of hip and knee arthroplasty to outpatient settings is an attractive option to shorten wait-times, reduce health system costs, and relieve hospital pressures, but the impact on patient-reported outcome measures (PROMs) is unclear. We examine the population-level uptake of orthopedic PROMs (EuroQoL-5D-5L; Oxford Hip/Knee Score) in Ontario, Canada since April 1, 2019. We explored factors associated with completion of pre-operative survey; PROMs scores; and reaching a minimal clinically significant improvement (MCSD). From 01Apr2024-31Mar2025, 41% (n = 19130) completed a pre-operative survey within 2 months of surgery, 14% completed a 3-5 month postoperative survey, and 15% completed a 9-15 month postoperative survey. Substantial hospital-level variation in reporting was observed. Pre-operative Oxford scores were higher (better) among outpatients (mean difference 1.8 points), and lower for females (-2.4 points), patients undergoing hip replacement (-2.1 points), and patients having higher comorbidity. A MCSD was observed for 53% of patients 3-5 months post-operatively and was more likely among outpatients [OR 1.28 (1.12-1.45)], hip replacement patients, rural residents, and among those having a higher baseline EQ5D score. Patients were less likely to reach the MCSD if they had a comorbidity score ≥4, if they resided in a long-term care setting, or resided in areas with higher concentrations of racialized or newcomer populations. Efforts to improve orthopedic PROMs reporting have had some success, but completion rates fall short of the 60% target. There was no evidence that patients undergoing outpatient hip/knee arthroplasty experienced worse QoL than inpatients, supporting ongoing efforts to promote outpatient surgery.