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Editorial   |    
A Concise Format for Reporting the Longer-Term Follow‐up Status of Patients Managed with Total Hip Arthroplasty
Robert Poss, MD, Deputy Editor; Charles R. Clark, MD, Deputy Editor for Adult Reconstruction; James D. Heckman, MD, Editor-in-Chief
J Bone Joint Surg Am, 2001 Dec 01;83(12):1779-1780
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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.
This format is to be used when the original full-length article was published in The Journal of Bone and Joint Surgery.
Length limit: Six manuscript pages, excluding references and figures.
Follow-up intervals: No less than five years since the previous publication and preferably at five or ten-year intervals, as long as no interim changes have occurred that require expedited reporting.

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
Galante J. Evaluation of results of total hip replacement [editorial]. J Bone Joint Surg Am,1990;72: 159-60. 72159  1990  [PubMed]
 

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References

Galante J. Evaluation of results of total hip replacement [editorial]. J Bone Joint Surg Am,1990;72: 159-60. 72159  1990  [PubMed]
 
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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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