Objective: To evaluate the appropriateness of the use of hip joint
replacements (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 fracture, or revision who were undergoing HJR were consecutively included
in the study during a 1-year period. The appropriateness of the indication was
judged by explicit criteria. Complications were recorded at the time of the
intervention and 3 months postoperatively.
Results: Of the 1,030 interventions, 604 were for osteoarthritis,
31 avascular necrosis, 191 fractures, and 204 revisions. No differences were
found among 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 were found in the rates of appropriateness among some centers. The
complication rate did not differ among the groups based on the level of
appropriateness of the procedure.
Conclusions: The appropriate use of HJR, as measured by the
criteria established by the panel, identified a moderate percentage of
inappropriate indications. Those equivocal and inappropriate cases demand
further studies to identify patients with an adequate risk-to-benefit ratio
from this procedure.