Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care

Abstract

The median age for total hip arthroplasty (THA) is over 70 years with the corollary that many individuals have multiple multimorbidities. Despite the predicted improvement in quality of life, THA might be denied even to those with low levels of multimorbidity. OBJECTIVE: To evaluate how pre-existing levels of multimorbidity influence the likelihood and timing of THA. SETTING: Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records. PARTICIPANTS: A total of 28?025 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register, Clinical Practice Research Datalink. Data were extracted from the database on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index and counts of chronic diseases (from list of 17), prescribed medications and number of primary care visits prior to recording of osteoarthritis. OUTCOME MEASURES: The record of having received a THA as recorded in the primary care record and the linked secondary care database: Hospital Episode Statistics. RESULTS: 40% had THA: median follow 10 months (range 1-17 years). Increased multimorbidity was associated with a decreased likelihood of undergoing THA, irrespective of the method of assessing multimorbidity although the impact varied by approach. CONCLUSION: Markers of pre-existing ill health influence the decision for THA in the elderly with end-stage hip osteoarthritis, although these effects are modest for indices of multimorbidity other than eFI. There is evidence of this influence being present even in people with moderate decrements in their health, despite the balance of benefits to risk in these individuals being positive.