[Validity and Reliability of the German Version of the HSS Expectation Questionnaire on Hip Joint Replacement]. / Validität und Reliabilität der deutschen Version des HSS-Erwartungsfragebogens zum Hüftgelenkersatz.

Background: Total hip arthroplasty is one of the most successful operations in medicine. The clinical result after surgery and compliance during rehabilitation are influenced by the patient's expectations. There is a lack of a validated German instrument to record these expectations in a standardised manner. Patients: 193 patients from the Dresden Hip Register with osteoarthritis of the hip were surveyed with respect to their expectations before the operation. The study sample consists of 108 women and 85 men. The average age of the patients was 59.7 years, with a standard deviation of 12.2 years. Methods: The Hospital for Special Patient Expectations Survey was translated into German and culturally adapted. In addition, the RKI demographic core data set, the HADS-D, LOT-R and the SCL-(K-)9 were collected to validate the instrument. In the statistical analysis, four main factors could be distinguished. These were "everyday activities", "pain relief and improvement in function", "medication and social participation" and "gait improvement". Results: Patients were predominantly married. 20 % of the women were widowed. 20 % had received higher education. Almost half of the patients were retired, 30 % were employed, 15.1 % self-employed and 7.3 % were unemployed. For most of the items, patients expected major improvements up to normalisation of their health. There were many different answers to several items, such as the question on occupation. For sporting and sexual activities no high expectations were given. The average expectation of the whole sample shows major differences to individual expectations. Men showed higher expectations for medication, social participation and gait improvement than did women. There were lower expectations for everyday activities, medication and social participation and gait improvement for older patients. Summary: The German version of the HSS patients expectation survey was validated. The instrument is useful in the preoperative setting to give the surgeon a first impression on the patient's expectations.

[Personality and comorbidity: are there "difficult patients" in hip arthroplasty?]. / Persönlichkeitsprofil und Komorbidität: Gibt es den "schwierigen Patienten" in der primären Hüftendoprothetik?

BACKGROUND: Concomitant disorders at the time of surgery in addition to psychological and socioeconomic patient characteristics may influence treatment outcomes in hip arthroplasty. OBJECTIVES: To describe the impact of these factors on perioperative complications and postoperative results in terms of function, quality of life, and patient satisfaction. MATERIALS AND METHODS: Review of relevant clinical studies, meta-analyses, and presentation of our own results. RESULTS: Comorbidities in general, especially in combination, increase the perioperative risk profile. Socioeconomic factors (education, professional qualifications, social deprivation) in addition to psychological variables (depression, distressed personality) can have a major impact on postoperative functional outcomes and patient satisfaction. CONCLUSIONS: It is of crucial importance to avoid inequalities in the provision of joint replacement for patients with hip osteoarthritis and co-existing risk factors. Preventive strategies should be implemented to reduce the negative impact of comorbidities on treatment outcome. Personalized communication and education may be helpful in avoiding unrealistic patient expectations before hip replacement.

Trends and geographical variation of primary hip and knee joint replacement in Germany.

OBJECTIVE: Considerable variation in total hip replacement and total knee replacement (THR/TKR) between regions has been described. The aim of this study was to explore geographical variation in THR and TKR in Germany and to analyse potentially explanatory variables. METHOD: We used data of Germany's largest statutory health insurer. Between 2005 and 2009 451,108 THR and 335,022 TKR were performed. Age-standardised joint replacement rates were calculated for 16 federal states and 407 counties. We performed cluster (Moran's I) and spatial error regression analyses including regional deprivation, osteoarthritis rate, urbanity and number of orthopaedic specialists as dependent variables on county level. RESULTS: In 2009 the overall age-standardised and crude rates were 148.9 (95% CI (confidence interval) 147.6-151.1) and 290.2 for THR, and 132.5 (95% CI 131.3-133.6) and 232.7 for TKR. Between counties THR rates differed by factor 2 (106.1-215.8) and showed significant clusters with high utilisation in South and Northwest Germany. TKR rates differed by factor 3.2 (69.1-219.5) and were also high in South Germany whereas almost all areas in East Germany showed low replacement rates. Differences were pronounced when restricting the analysis to cases with an indication of osteoarthritis. All tested predictors could be identified as significant explanatory variables (each P < 0.001). CONCLUSION: This study proofed considerable and consistent geographic variation of THR and TKR in Germany. Thereby relevant explanatory factors were identified. These results may foster the discussion and future research in health services which should include areas of patients' and doctors' expectation, financial aspects and an outcome-based definition of appropriate supply.