To evaluate the evidence that changes in health-related quality of life (QOL) follow total hip replacement (THR).

MEDLINE was searched from 1966 to 1995 inclusive using the MeSH 'hip prosthesis', 'health status', 'quality of life' and 'outcomes'. The latter three subject headings were also used as textwords. Reference lists from identified articles were examined for additional studies.

Study designs of evaluations included in the review

Prospective, retrospective and cross-sectional studies were included in the review.

Specific interventions included in the review

THR or total knee replacement.

Participants included in the review

Patients undergoing THR, the indication for which was normally osteoarthritis, were included.

Outcomes assessed in the review

Multidimensional changes in health-related QOL. Studies had to evaluate two or more of the following dimensions: physical (including pain and mobility), social (e.g. social interaction and role function), emotional (e.g. perceived mental well-being), economic (e.g. use of community and welfare resources) and overall satisfaction. A variety of instruments (listed in the review) were used to measure health-related QOL.

How were decisions on the relevance of primary studies made?

The authors do not state how the papers were selected for the review, or how many of the authors performed the selection.

No formal assessment of validity was undertaken, although methodological issues were discussed.

The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction.

How were the studies combined?

A detailed qualitative review of the included studies is presented.

How were differences between studies investigated?

No statistical test of heterogeneity is reported, although the authors discuss differences between trials in the narrative.

Twenty studies were included in the review: 11 prospective (pre-operative and post-operative assessment of QOL; n=793), 7 retrospective (n=2,267), 1 cross-sectional (n=212) and 1 retrospective with prospective component (n=90).

All of the reviewed studies showed improvement in health-related QOL after elective total hip replacement. Improvement most often occurs within the first 3 to 6 months after THR, although some physical measures take longer.

THR often leads to dramatic improvements in QOL. Future research should assess the impact of both patient-level predicators and the role of various surgical approaches in contributing to successful outcomes after THR.

The review's inclusion criteria are clear, and good details of the primary studies are reported in a narrative review and tabular format. The search strategy on which the review is based is limited to MEDLINE and a review of reference lists of identified articles. No attempt was made to identify unpublished articles and, as discussed by the authors of the review, publication bias is likely to favour the reporting of only positive outcomes after THR. No formal validity assessment of the primary studies is reported, but methodological issues associated with the included studies are discussed clearly.

THR has become one of the most successful and cost-effective operations ever introduced. The review's objectives are relevant to the subject area, and the conclusions are sound.

As discussed in the review, future research should assess the impact of both patient-level predicators and the role of various surgical approaches in contributing to successful outcomes after THR.

Arthritis Foundation (Maryland Chapter), Engalitcheff Research Fund.

Towheed T, Shea B, Wells G, Hochberg M. Osteoarthritis: a systematic review of randomised controlled trials of analgesia and anti-inflammatory therapy in osteoarthritis (OA) of the hip (Cochrane Review). In: The Cochrane Library, Issue 2, 1998. Oxford: Update Software.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.