The past few years have seen a growth of interest in outcome measurement in
a variety of settings including audit, health care management and commissi
oning - besides the traditional applications in research work. This paper r
eports on a study of the outcomes of total knee replacement in an acute hos
pital where the outcomes were studied as part of an audit process. The outc
ome measures used included clinical and symptomatic measures as well as gen
eric health status scales. The initial study in one hospital was expanded t
o include a number of others in the same region and a comparative database
of outcomes developed. Examples of the results are shown. The technical mea
sures using knee scores and general health status measure show significant
improvement from pre-operatively to 3 months later. This improvement was ma
intained up to the 1-year follow-up on both measures. Although the informat
ion systems for collecting and measuring outcomes has been successful, the
ability of such measures to lead to behavioural change has been limited. Th
e problems in using outcome measures are discussed in particular in the con
text of an audit within hospitals, and for purchasing agencies.