Yu, D ORCID: 0000-0002-8449-7725, Jordan, KP ORCID: 0000-0003-4748-5335, Snell, K, Riley, R ORCID: 0000-0001-8699-0735, Bedson, J, Edwards, J, Mallen, CD ORCID: 0000-0002-2677-1028, Tan, V, Ukachukwu, V, Prieto-Alhambra, D, Walker, C and Peat, G ORCID: 0000-0002-9008-0184 (2018) Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink. Annals of the Rheumatic Diseases. ISSN 0003-4967

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Abstract

Objectives
The ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.

Methods
We identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.

Results
45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).

Conclusions
Two prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via BMJ Publishing Group at http://dx.doi.org/10.1136/annrheumdis-2018-213894 - please refer to any applicable terms of use of the publisher.
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 19 Oct 2018 08:09
Last Modified: 19 Oct 2018 08:09
URI: http://eprints.keele.ac.uk/id/eprint/5429

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