PRIORITEES Study
Research type
Research Study
Full title
Predicting Rapid Increases in severity by Obligate Rotation & Improving Total hip Expedited Elective Surgery (PRIORITEES); A novel study evaluating patients awaiting total hip arthroplasty.
IRAS ID
319787
Contact name
Tosan Okoro
Contact email
Sponsor organisation
The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Duration of Study in the UK
0 years, 9 months, 1 days
Research summary
Hip replacements are one of the NHS’s highest volume procedures, with ~14,000 operations per month pre-pandemic. Delays to surgery can have significant implications; meaning increasing levels of pain and worsening quality of life (QoL).
As of January 2021, following the initial waves of the COVID-19 pandemic, 58,000 people had waited an average of 25 additional weeks for their total hip replacement (THR). From prior research, on the QoL scale 0-1, waiting an additional week for a THR reduces QoL by 0.00062. For a wait of 25 weeks, this is a 1.4% loss in QoL, equivalent to 5 days of perfect health per year.
A recent systematic review by Tierlick et al (2019) assessed the evidence of patient, health and prognostic variables associated with the progression of hip osteoarthritis (OA) and found consistent evidence that four factors (comorbidities, Kellgren-Lawrence (KL) grade, superior/superolateral femoral head migration, and subchondral sclerosis) were the main predictors of hip OA progression with evidence for other factors weak or conflicting.
Obligatory external rotation (OER, Drehmann sign) is typically noted in paediatric patients with slipped femoral capital epiphysis when the hip is passively flexed to 90 degrees. In patients with ‘decompensated’ hip OA where there is femoral head collapse, this clinical sign is also evident, and can also signify progression of hip OA.
The primary aim of this study is to evaluate the factors, including OER, that are associated with risk of progression in hip OA. The secondary aim of this study is to develop a simple grading system based on the aforementioned results, to evaluate the feasibility of aiding clinicians in prioritising patients for THR in the current climate of significantly increased waiting lists. We hope to further validate the assessment of obligate external rotation remotely using a camera to guide remote assessment of this score.REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
23/YH/0007
Date of REC Opinion
24 Jan 2023
REC opinion
Favourable Opinion