This 2004 systematic review searched Medline and EMBASE (1980-2003) and analyzed 74 prospective cohort studies evaluating THA and TKA outcomes using validated patient-reported HRQOL instruments. It asks: what do SF-36, WOMAC, and utility measures tell us about who benefits from joint replacement, by how much, and what predicts that benefit?
Arthroplasty decisions were historically guided by radiographic severity, surgeon preference, and age cutoffs — with limited attention to patient-reported function as either an indication or outcome benchmark.
This review reframes the decision: radiographic grade does not predict 12-month WOMAC pain or function scores after THA, so symptoms and patient-reported HRQOL should drive surgical timing, not X-ray changes alone.
When counseling patients preoperatively, use their baseline WOMAC and SF-36 scores to set expectations. A patient with severe baseline impairment will gain the most points but is unlikely to reach the same absolute function as someone who presented less disabled. This is a teachable moment at the consent visit.
Age over 80 and obesity (even BMI >40) are not contraindications based on HRQOL data. Withholding surgery on these grounds alone is not supported by the evidence. One practical nuance: patients waiting more than 6 months experience measurable HRQOL and mobility losses that are not recovered after surgery. A compelling argument for timely scheduling once the decision to operate is made.
This 2004 systematic review searched Medline and EMBASE (1980-2003) and analyzed 74 prospective cohort studies evaluating THA and TKA outcomes using validated patient-reported HRQOL instruments. It asks: what do SF-36, WOMAC, and utility measures tell us about who benefits from joint replacement, by how much, and what predicts that benefit?
Arthroplasty decisions were historically guided by radiographic severity, surgeon preference, and age cutoffs — with limited attention to patient-reported function as either an indication or outcome benchmark.
This review reframes the decision: radiographic grade does not predict 12-month WOMAC pain or function scores after THA, so symptoms and patient-reported HRQOL should drive surgical timing, not X-ray changes alone.
When counseling patients preoperatively, use their baseline WOMAC and SF-36 scores to set expectations. A patient with severe baseline impairment will gain the most points but is unlikely to reach the same absolute function as someone who presented less disabled. This is a teachable moment at the consent visit.
Age over 80 and obesity (even BMI >40) are not contraindications based on HRQOL data. Withholding surgery on these grounds alone is not supported by the evidence. One practical nuance: patients waiting more than 6 months experience measurable HRQOL and mobility losses that are not recovered after surgery. A compelling argument for timely scheduling once the decision to operate is made.