Patient-reported outcome measures (PROMs) have become essential tools to inform improvements in healthcare quality and ensure people‑centred care (see section on “Person centredness of primary care”). PROMs are often used as an indicator of the quality of care, including for acute care such as hip and knee replacement surgery. They are used to monitor and promote delivery of patient-centred care as they provide information on outcomes from the patient’s perspective, including, for example whether the care they received was aligned with their individual goals and needs. Given the increasing use of PROMs to assess the quality of care in recent years, the number of people responding to PROMs requests in relation to hip and knee replacement surgery has increased across countries (Kendir et al., 2022[1]).
Figure 6.32 shows changes between the pre‑operative and post-operative scores on the Oxford Hip Score (OHS) scales reported by patients after elective hip replacement surgery for osteoarthritis, which are available in joint replacement registries across OECD countries. Figure 6.33 shows changes between the pre‑operative and post-operative scores reported by patients using the Oxford Knee Score (OKS) after elective knee replacement surgery for osteoarthritis. Figure 6.34 shows quality of life of patients measured by the EuroQol 5‑Dimensional tool (EQ‑5D) covering mobility, self-care, usual activities, pain/discomfort and anxiety/depression before and after hip or knee replacement surgery.
Changes from pre‑operative to post-operative scores show that, on average, patients reported improvements in their conditions and in their quality of life after operations. For hip surgery, post-operative OHS increased substantially in all countries. Finland recorded the highest post-operative score, from 23 to 45, while Germany is the only country that remained below 40, with a post-operative score of 37 (Figure 6.32). For knee replacement surgery, all countries also reported post-operative gains, with a pre‑operative OKS range of 19‑25 increasing to 36‑41 after surgery (Figure 6.33). Finland again showed the highest post-operative score at a score of 41. In relation to quality of life, for hip replacements, EQ‑5D scores rose from a range of 0.26‑0.59 before surgery to 0.77‑0.90 after surgery; for knee replacements, scores improved from a range of 0.49‑0.66 before surgery to 0.68‑0.88 after surgery (Figure 6.34).
The extent of improvements (i.e. the average change between pre‑ and post-operative scores) was similar between men and women for specific health conditions and quality of life for both types of operations. However, women had lower pre‑ and post-operative scores for the conditions related to the operation and overall quality of life in all countries for both types of surgery. This highlights the need for healthcare systems to consider how diseases manifest and progress differently in men and women, and to ensure that care responds appropriately to these differences (see Chapter 2).
It should be noted that variations in post-operative scores reflect not only cross-country differences in the quality of hip and knee replacement surgery but also other factors beyond the healthcare received – notably, differences in socio-demographic and clinical characteristics of patients reporting PROMs. Caution is therefore needed when interpreting variations across countries. While international comparability of data remains limited for a few countries, more countries have been making efforts to measure the quality of care for people undergoing hip and knee replacement surgery from the perspective of patients. Examples include recent national- level hip and knee PROMs data collections in Norway and Slovenia.
