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OBJECTIVES: The objective was to examine whether the Oxford Hip Score (OHS) demonstrated a floor or a ceiling effect when used to measure the outcome of hip replacement surgery in a large national cohort. SETTING: Secondary database analysis of a national audit conducted in England and Wales on patient undergoing hip and knee arthroplasty in a secondary care setting. PARTICIPANTS: 93 253 primary arthroplasty patients completed preoperative OHS questionnaires and 69 361 completed 6-month postoperative OHS questionnaires. The population had a mean age of 67.78 (range 14-100, SD 11.3) and 59% were female. PRIMARY SECONDARY OUTCOME MEASURES: Primary outcome measure was the Oxford Hip Score (OHS). Secondary outcome measures were the OHS-FCS and OHS-PCS. Floor and ceiling effects were considered present if >15% of patients achieved the worst score/floor effect (0/48) or best/ceiling effect (48/48) score. RESULTS: Preoperatively, 0% of patients achieved the best score (48) and 0.1% achieved the worst score (0). Postoperatively, 0.1% patients achieved the worst score, but the percentage achieving the best score increased to 11.6%. Subgroup analyses demonstrated that patients between 50 and 59 years of age had the highest postoperative best score, at 15.3%. The highest postoperative OHS worst score percentage was in a group of patients who had a preoperative OHS above 41/48 at 28%. Furthermore, 22.6% of patients achieved the best postoperative OHS-PCS and 19.9% best postoperative OHS-FCS. CONCLUSIONS: Based on NHS PROMS data the overall OHS does not exhibit a ceiling or floor effect and should continue to be used as a valid measure of patient-reported outcomes for patients undergoing total hip arthroplasty. However, subscale analysis does indicate some limitations in the OHS-PCS and OHS-FCS. TRIAL REGISTRATION NUMBER: NDORMS. Introducing standardised and evidence-based thresholds for hip and knee replacement surgery. The Arthroplasty Candidacy Help Engine (ACHE tool). HTA Project 11/63/01.

Original publication




Journal article


BMJ Open

Publication Date





ORTHOPAEDIC & TRAUMA SURGERY, Adult, Age Distribution, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, England, Female, Humans, Male, Medical Audit, Middle Aged, Pain Measurement, Pain, Postoperative, Patient Outcome Assessment, Severity of Illness Index, State Medicine, Surveys and Questionnaires, Wales