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PAPERS: Max Reijman, J M W Hazes, H.A.P Pols, R M D Bernsen, B W Koes, and S M A Bierma-Zeinstra Role of radiography in predicting progression of osteoarthritis of the hip: prospective cohort study BMJ 2005; 330: 1183 [Abstract] [Full text]

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Is this really helpful to orthopaedic Surgeons?

Chatenya Chauhan   (28 May 2005)

Is this really helpful to orthopaedic Surgeons? 28 May 2005
Chatenya Chauhan, Consultant Orthopaedic Surgeon Southend Hospital SS0 0RY Send response to journal: Re: Is this really helpful to orthopaedic Surgeons?	The doctrine seen in the literature, and echoed by practical experience is such that there is little correlation between the symptoms that a patient feels and the changes seen on x-ray. In this study only 13.1% of patients had progression of their disease and only 35.8% of these went on to have a joint replacement. This means 4.69% of the original population went on to have a replacement surgery within 6.6 years. Therefore given these facts it seems reasonable to continue monitoring patients on a clinical basis only. The implication of this study would be to monitor our patients by screening them with x-rays. I fear that we would be increasing the risks of cancer. Patients that may well be assessed clinically by use of simple tools such as the Oxford Hip or Oxford Knee score. These tools have already been validated and would more than adequate to pick up the 5% of patients that will need a replacement. I must be remembered that the assessment of a patient for the need for a hip replacement is not one of radiological analysis alone. It requires an assessment of lifestyle, health and intercurrent disease states, as well as assessing the patient needs and expectations and also whether the operation is doable for any particular patient before offering a joint replacement operation. Competing interests: None declared