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© 2022 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

The median age for total hip arthroplasty (THA) is over 70 years with the corollary that many individuals have multiple multimorbidities. Despite the predicted improvement in quality of life, THA might be denied even to those with low levels of multimorbidity.

Objective

To evaluate how pre-existing levels of multimorbidity influence the likelihood and timing of THA.

Setting

Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records.

Participants

A total of 28 025 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register, Clinical Practice Research Datalink. Data were extracted from the database on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index and counts of chronic diseases (from list of 17), prescribed medications and number of primary care visits prior to recording of osteoarthritis.

Outcome measures

The record of having received a THA as recorded in the primary care record and the linked secondary care database: Hospital Episode Statistics.

Results

40% had THA: median follow 10 months (range 1–17 years). Increased multimorbidity was associated with a decreased likelihood of undergoing THA, irrespective of the method of assessing multimorbidity although the impact varied by approach.

Conclusion

Markers of pre-existing ill health influence the decision for THA in the elderly with end-stage hip osteoarthritis, although these effects are modest for indices of multimorbidity other than eFI. There is evidence of this influence being present even in people with moderate decrements in their health, despite the balance of benefits to risk in these individuals being positive.

Details

Title
Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care
Author
Ferguson, Rory 1   VIAFID ORCID Logo  ; Prieto-Alhambra, Daniel 2   VIAFID ORCID Logo  ; Peat, George 3   VIAFID ORCID Logo  ; Delmestri, Antonella 1   VIAFID ORCID Logo  ; Jordan, Kelvin P 3   VIAFID ORCID Logo  ; Strauss, Vicky Y 2 ; Valderas, Jose Maria 4   VIAFID ORCID Logo  ; Walker, Christine 5 ; Yu, Dahai 3   VIAFID ORCID Logo  ; Glyn-Jones, Sion 1 ; Silman, Alan 1   VIAFID ORCID Logo 

 Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK 
 Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK 
 Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK 
 Health Services and Policy Research Group, Medical School, University of Exeter, Exeter, UK 
 Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK 
First page
e046713
Section
Rheumatology
Publication year
2021
Publication date
2021
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2665125719
Copyright
© 2022 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.