Background to the research:
Frailty is a common and widely recognised health issue in older people. People who are frail are more likely to be ill and may be less able to recover from surgery. Hip and knee replacement surgery for end stage joint disease (osteoarthritis) are among the most frequently performed operations in older people, however, we dont know how frailty effects the risks and benefits of hip or knee replacement surgery in this group.
Aim:
To find out how frailty affects the risks and benefits of joint replacement surgery in older people with osteoarthritis including the risk of death following surgery, as well as changes in pain and the ability to carry out basic daily activities. We will look at whether frailty is associated with how people utilise healthcare services following joint replacement surgery. We will also look at whether joint replacement surgery may lead to improvement or worsening of frailty.
Design and methods used:
A new method of measuring frailty, using existing electronic health records, has recently been developed and this will be used in our study. Data from the CPRD will be linked to other databases to investigate how frailty impacts on outcomes following hip and knee replacement surgery for osteoarthritis, including mortality, patient reported outcome measures, and healthcare utilisation.
Background:
The impact of frailty on health outcomes following hip and knee joint replacement is unknown.
Objectives:
To determine whether:
(i) the impact of frailty on short-term term (<1 year) and long-term (>1 year) mortality risk and also healthcare utilisation following total hip/knee replacement is different compared to the impact of frailty on mortality risk and healthcare utilisation over the same period in people who do not have a total hip/knee replacement
(ii) frailty impacts on the change in hip/knee pain and function following total hip/knee replacement surgery
(iii) the longitudinal progression of frailty is different in people with osteoarthritis (OA) compared to people without OA
(iv) having a total hip/knee replacement impacts on the longitudinal change / progression of frailty
(v) the prevalence of frailty in people who have a total hip/knee replacement has changed during the period 1998 to 2019 and whether frailty may explain the association between deprivation and the likelihood of receiving total hip/knee arthroplasty
Methods:
Frailty will be determined using a frailty index. Cox and Poisson regression, respectively will be used to determine the impact of frailty on mortality and healthcare utilisation, in people who have a hip/knee replacement compared to participants who do not have a total hip/knee replacement.
Linear regression will be used to determine whether frailty impacts on the change in patient-reported outcomes 6 months after hip or knee replacement surgery. Multilevel models will be used to analyse prospective change in frailty index in people who have a hip/knee replacement compared to those who do not have surgery and also in people who have OA compared to those who do not have OA. Multivariable Poisson regression models will be used to determine whether the prevalence of frailty in people who have total hip or knee replacement surgery has changed over time.
- All-cause and cause-specific mortality;
- Healthcare utilisation (primary care consultations, inpatient, outpatient, and A&E attendances)
- Patient reported outcome measures: EuroQol 5-dimension (EQ-5D), Oxford Hip Score/Oxford Knee Score (OHS/OKS), patient reported satisfaction (How would you describe the results of your operation?) and improvement (Overall, how are the problems now in the hip on which you had surgery, compared to before your operation?)
- Frailty measured using a frailty index (FI)
Terence O'Neill - Chief Investigator - University of Manchester
Michael Cook - Corresponding Applicant - University of Manchester
Darren Ashcroft - Collaborator - University of Manchester
Mark Lunt - Collaborator - University of Manchester
Tim Board - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;HES PROMS (Patient Reported Outcomes Measure);ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation