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BMJ Open. 2018 Apr 10;8(4):e019477. doi: 10.1136/bmjopen-2017-019477.

Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

Author information

Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Max Planck Institute for Demographic Research, Rostock, Germany.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Faculty of Medicine, University of Southampton, Southampton, UK.



To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS).


Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases.


UK secondary care.


Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year.


EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement.


Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution.


Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with preoperative symptoms measured by OHS/OKS.


costs; hip replacement; knee replacement; oxford hip score; oxford knee score; quality-of-life

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: HAD reports personal fees from Halyard Health, outside the submitted work. NKA reports grants from Bioiberica, personal fees from Bioventus, personal fees from ESCEO, personal fees from Flexion, personal fees from Freshfields Bruckhaus Deringer, personal fees from Merck, personal fees from Regeneron, outside the submitted work.

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