The Journal is receiving an increasing number of
manuscripts that report longer-term follow-up results of total hip
arthroplasty. Many of these reports extend findings that were originally
published in The Journal and are unnecessarily
long because they repeat a great deal of information that is already
available. Therefore, to provide a guide to investigators, we sought
to identify the essential information to be included in such a report. Our
goal was for The Journal to convey the most meaningful
information to its readers while saving both authors and readers
from redundancy.
We created this format through an iterative process. In May 2001,
we solicited opinions regarding the essential content of such a
report from twelve authorities in total hip arthroplasty who either
are frequent contributors to The Journal or serve
as reviewers and/or editors. We collated their responses
and then discussed their consensus views at a meeting of the Deputy
Editors of The Journal in September 2001. The format
presented at the end of this editorial represents the synthesis
of recommendations from experts in the field of hip reconstruction
and from orthopaedic editors active in clinical research, basic
research, and outcomes assessment.
The format is intended to be a template that, while limiting
space, leaves abundant opportunity for authors to state their major
findings and the importance of those findings. We strongly encourage
the inclusion of certain outcomes data that, although not currently
included in many follow-up studies of total hip arthroplasty, will,
we believe, become part of every report after a reasonable transition
period. Specifically, investigators should use the WOMAC (Western
Ontario and McMaster University Osteoarthritis Index), a validated,
patient-administered instrument that assesses the effect of arthroplasty on
pain, stiffness, and function in patients with osteoarthritis. The
inclusion of data derived with this index should allow more meaningful
comparisons of the fates of individual cohorts over time, facilitate
comparison of results from different centers using different prostheses, and
enable more accurate meta-analyses.
Soon, we will develop similar formats for reporting longer-term
follow-up results of other reconstructive procedures.
Over the past decade, steady progress has been made toward the
adoption of standardized nomenclature and validated instruments
for reporting the results of total hip arthroplasty1. We believe that the step taken by The
Journal will encourage further advances toward that goal
and thus help both investigators and readers to clarify the abundant
information regarding total hip arthroplasty with dependable and
powerful tools.
Abstract
State, in a maximum of 150 words, why you are reporting the results
at this interval and your major findings.
Background
Briefly summarize and cite the original study published in The
Journal of Bone and Joint Surgery. Describe the original:
• patient cohort
• type of arthroplasty and critical aspects of surgical and cementing
or cementless techniques
• type of series (Was this a selected or unselected series? A consecutive
series? Were the operations performed by a single surgeon? By multiple
surgeons? At multiple institutions? Were data acquired prospectively
or retrospectively?)
Methods
List, but do not describe, the methods used to assess clinical
and radiographic results and cite the appropriate reference.
For reporting clinical results:
• you may use the same assessment scheme employed in your previous
report—e.g., Harris, Hospital for Special Surgery, Iowa,
Mayo Clinic, or Merle d’Aubigné-Postel rating
system
• you are strongly encouraged to include the WOMAC scores for the
current cohort
• you are encouraged to use the clinical and radiographic nomenclature
described by Johnston et al. (J Bone Joint Surg. 72-A: 161-8, Feb. 1990) for
other pertinent data
• you must perform survivorship analyses (with
calculation of confidence limits) using end points that are appropriate
to your cohort
Results
The results should include:
• the original number of patients/hips studied and the number
of patients/hips studied since the last report
• the number of patient who died, the number of patients/hips
who were lost to follow-up, and the number of patients/hips
currently being studied
• the number of patients/hips in the updated series who were
examined, the number who responded to questionnaires, and the number
with available radiographs
• the number of patients/hips in whom the primary joint replacement
is still intact
• basic demographic characteristics of the cohort,
especially any that might affect results (age, diagnosis, gender,
height, weight, and level of activity)the number of arthroplasties
revised for any reason. If the revised arthroplasties are included
in the current series, report the status in this group separately
• complications
since the last report, including infection, dislocation, stem breakage,
osteolysis, wear, and so on
For survivorship analysis, the following end points should be
used:
(1) revision for any cause—e.g., aseptic loosening, osteolysis,
component breakage, or infection
(2) revision for aseptic loosening
of the femoral component
(3) revision for aseptic loosening of the
acetabular component
(4) definite radiographic loosening of the femoral
component, according to the criteria of Harris et al. (J Bone Joint Surg. 64-A: 1063-7, Sept. 1982)
for cemented stems and the criteria of Engh et al. (J Bone Joint Surg. 69-B: 45-55, Jan. 1987) for
uncemented stems. If your results cannot be evaluated with these
criteria, cite the appropriate reference for your rating criteria
(5) definite
radiographic loosening of the acetabular component, according to
the criteria of Hodgkinson et al. (
Clin Orthop. 228: 105-9, 1988)—i.e.,
migration or >1 mm of radiolucency in all DeLee and Charnley
zones. If your results cannot be evaluated with these criteria,
cite the appropriate reference for your rating criteria
Conclusions
The conclusions should include:
• major factors limiting the longevity of the prosthesis at the
time of this follow-up
• recommendations regarding the continued use
of the prosthesis if it is still available
• if the prosthesis is not
still available, lessons applicable to the current successor or
to similar designs