About Dataset

Data licence: Open Government Licence v3.0. link

Introduction

Hip replacements are common worldwide, but reasons for surgery and prevalence vary regionally. This dataset and analysis focus on understanding the underlying factors and evaluating patient outcomes using post-operative survey data.

Reasons for Hip Replacements

• Osteoarthritis (Degenerative Joint Disease): Most common cause. Influenced by age, obesity, genetics, and injury.
• Rheumatoid Arthritis: Inflammatory condition leading to joint damage requiring surgery.
• Hip Fractures: Often due to trauma or osteoporosis, particularly in elderly individuals.
• Avascular Necrosis: Bone tissue death from disrupted blood flow. Causes include trauma, alcohol, and steroids.
• Congenital Hip Disorders: Conditions like developmental dysplasia (DDH) can lead to instability and pain, often requiring surgery.

Regional Differences

Japan

• Diet & Lifestyle: Fish-rich diets and regular low-impact activity help preserve joint health.
• Cultural Norms: Daily physical activity (e.g., walking, tai chi) helps prevent joint deterioration.
• Healthcare Access: Universal health coverage promotes early intervention and preventative care.

Western Northern Hemisphere Countries

• Obesity: Higher obesity rates increase pressure on joints, accelerating wear.
• Sedentary Lifestyle: Prolonged sitting and inactivity contribute to joint stiffness and muscle weakness.
• Ageing Populations: Increased age correlates with higher hip replacement demand.
• Healthcare Disparities: Unequal access impacts preventative care and early detection.

Types of Surgical Procedures

Hip Replacement (Arthroplasty)

• Total Hip Replacement (THR): Most common procedure; entire joint is replaced with prosthetics.
• Partial Hip Replacement: Replaces only the femoral head; often used for femoral neck fractures.
• Resurfacing Hip Replacement: Caps femoral head instead of removing; for younger, active patients.

Hip Pinning (Internal Fixation)

• Dynamic Hip Screw (DHS): Screw and plate system allowing controlled movement to promote healing.
• Cannulated Screws: Hollow screws guided into bone to secure fractures.
• Intramedullary Nailing: Metal rod inserted into the femur for complex fractures.
• Garden Screw Fixation: Screws stabilising the acetabulum area in pelvic fractures.

Provisional Patient Reported Outcome Measures (PROMs) – England

Since April 2009, patients undergoing hip/knee replacement surgeries are invited to complete pre- and post-operative questionnaires:

Condition-Specific Measures

• Oxford Hip Score (OHS): 12-question form to assess pain and hip function. link
• Oxford Knee Score (OKS): Similar format for knee assessment. link

General Health Measures

• EQ-5DTM Index: Measures five dimensions: mobility, pain/discomfort, anxiety/depression, self-care, and daily activity.
• EQ VAS: Visual scale from 0–100 representing overall health.

Additional Feedback

• Patient satisfaction and perceived success of the operation post-surgery.

Data Visualisations

Data from “Key Facts Hip and Knee Replacements 2223.csv” visualised using Google Sheets and R:

Survey Results – Average Hip Procedure Outcomes

• EQ VAS (General Health): 67.53% improved, 6.70% unchanged, 25.80% worsened.
• EQ-5D Index (Quality of Life): 89.23% improved, 5.60% unchanged, 5.17% worsened.
• Oxford Hip Score (Hip Function): 95.07% improved, 1.17% unchanged, 3.73% worsened.

Possible Explanations for Discrepancies

• Measure Specificity: EQ VAS is general; Oxford Hip Score is more targeted.
• Subjective Interpretation: Different perception of questions may influence scoring.
• Severity & Expectations: Patients with severe conditions may report lower satisfaction despite improvement.
• Pain Sensitivity: Varies across individuals, impacting subjective scores.

Further Visualisations using R

• Box plots comparing outcome percentages by status (Improved, Unchanged, Worsened).
• Pie chart summarising overall distribution of results across questionnaires.
• Combined dashboard view with custom colours and annotations.
• R code and Markdown documents included. link

Conclusion

The analysis demonstrates that hip procedures generally lead to significant improvements in:

• Self-reported health (EQ VAS)
• Quality of life (EQ-5D)
• Hip function (Oxford Hip Score)

While some patients report no change or worsening, most benefit substantially. Differences across regions like Japan vs Western countries are shaped by lifestyle, diet, healthcare access, and societal factors. A comprehensive approach to prevention and care is key to maintaining long-term hip health and mobility.

Author: Patrick Ford 🩻