ArticleBMJ open2021
Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Preoperative pathways in adults with multiple long-term conditions undergoing major surgery: a systematic review.BMJ open · 2026Pooled it
- Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review.Annals of medicine · 2023Pooled it
- The association between frailty and mortality among lower limb arthroplasty patients: a systematic review and meta-analysis.BMC geriatrics · 2022Pooled it
- The projected economic burden and complications of revision hip and knee arthroplasties: Insights from national registry studies.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Review
- Association of preoperative health status with risk of complications after primary total hip arthroplasty: how useful are the measures self-rated health, ASA classification and comorbidity count?BMC musculoskeletal disorders · 2025Article
- Association between multimorbidity and quality of life after hip replacement surgery: analysis of routinely collected patient-reported outcomes.British journal of anaesthesia · 2025Article
- Observational
- The impact of frailty on patient-reported outcomes following hip and knee arthroplasty.Age and ageing · 2022Article
- Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty : seven to eight years' follow-up.Bone & joint open · 2022Article
- Article
- Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care.BMJ open · 2021Article
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.
objectiveTo evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.
settingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.
participantsA total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA. OUTCOME MEASURES: (1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.
resultsPerioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.
conclusionsIndependent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.
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