Evaluation of the appropriateness of hip joint replacement techniques

Objective: To evaluate the appropriateness of the use of hip joint replacem ents (HJRs) using explicit criteria developed by an expert panel. Methods: Observational study. Nine hundred ninety-seven patients from five hospitals with a diagnosis of osteoarthritis, avascular necrosis, hip fract ure, or revision who were undergoing HJR were consecutively included in the study during a 1-year period. The appropriateness of the indication was ju dged by explicit criteria. Complications were recorded at the time of the i ntervention and 3 months postoperatively. Results: Of the 1,030 interventions, 604 were for osteoarthritis, 31 avascu lar necrosis, 191 fractures, and 204 revisions. No differences were found a mong the hospitals for the main clinical and patient variables. indications for surgery were considered appropriate in 59% of cases, uncertain in 32%, and inappropriate in 8%, mainly in the osteoarthritis group. Differences w ere found in the rates of appropriateness among some centers. The complicat ion rate did not differ among the groups based on the lever of appropriaten ess of the procedure. Conclusions: The appropriate use of HJR, as measured by the criteria establ ished by the panel, identified a moderate percentage of inappropriate indic ations. Those equivocal and inappropriate cases demand further studies to i dentify patients with an adequate risk-to-benefit ratio from this procedure .