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PROMS: Evaluating Health Gains and Patient Satisfaction

Patient-Reported Outcome Measures (PROMs)

PROMs calculate the health gains after surgical treatment from a patient perspective. This can contribute to the analysis of revision rates, identifying patients with persistent pain or disability, as well as measuring patient satisfaction after surgery. Therefore, many registries and hospitals have started to record PROMs data. There is a growing demand for feasible methods and instruments to collect comprehensive PROMs and to enable data comparison between the registries. This is the first year that NJR and AOA NJRR began introducing PROMs in a separate section. Reporting PROMs at the implant brand level is a trend for the future.


As of this year, the NJR introduced PROMs in an additional section, focusing primarily on evaluating the integration of available PROMs data with the entire report and describing current ideas on reporting hip and knee PROMs at an implant brand level in future years.1


In 2021, the Australian Registry started to form a new chapter to provide basic information on PROMs. The Australian Registry uses the EQ-VAS and EQ-5D-5L to measure quality of life and the Oxford Hip Score (OHS) to assess pain and function. In general, a large improvement in quality of life, joint-specified pain and function has been achieved for all classes of joint replacement.2


According to the AJRR, 401 sites out of 1,251 (32%) have submitted PROMs up to 31st December 2021, marking a 38% increase compared to the previous Annual Report. Results of the HOOS, JR. score demonstrates that 91% of the patients achieved a meaningful improvement after elective primary THR.4


The NZJR was one of the first joint registries to collect PROMs data. The validated Oxford Hip outcome questionnaires have been sent out on a random selection basis since July 2002 achieving an annual response rate of 20%. The Oxford-12 questionnaire includes 12 questions which can be scored  from 4 to 0. The maximum score of 48 indicates normal function, 0 represents most severe disability.

According to the statistics recorded in the NZJR Annual Report 2022, the average scores are 40.36, 42.37, 41.94 and 41.37, 40.67 at six months, five years, ten years, fifteen years and twenty years, respectively, after surgery.5


The LROI uses NRS (rest), NRS (activity), EQ5D index score, EQ5D thermometer, HOOS-PS score, Oxford Hip score, Anchor question: Daily functioning to measure PROMs for patients underwent hip arthroplasty procedures. According to the LROI, the response rate of pre-operative PROMs was 63.1% in 2021. The response rate of all three pre-operative, 3 and 12 months postoperative in 2020 was 34.7%.7

Worth Knowing

Pandemic Impact

There is still a significant influence due to the COVID-19 pandemic on the volume of hip replacements. However, the impact of pandemic in 2021 was less severe than in 2020. The Australian Registry reported 19,595 fewer joint replacement procedures than expected over the last two years (2020-2021). The NJR also confirmed that activity in 2020 was roughly half that of normal pre COVID-19, which has recovered to 70-85% in 2021. According to the Swedish Registry, the total number of reported THR decreased by 25% in 2020 compared to the number in 2019. In 2021, the impact of pandemic eased and increased 16% compared to the number of procedures performed in 2020. The AJRR also reported a 14% procedural volume growth compared to the 2020 in 2021.

Dual Mobility

In all analyzed registries, the use of dual mobility bearings has steadily increased over the years.1-5,7 The NJR confirms that the CoPoM dual mobility bearings show lower revision than the MoPoM combinations, but with no significant difference.1

Hip Resurfacing

Metal resurfacing is still restricted to a carefully monitored patient selection. Women are mostly excluded from this procedure. Ceramic resurfacing procedures are recorded by the NJR and AOA NJRR.

According to the NJR, CoC and MoP resurfacings are now being implanted and in future annual reports these will be reported as a new category, although the numbers are likely to remain too small for meaningful analysis for a number of years yet.

298 CoC hip resurfacing procedures have been documented by the AOA NJRR with a cumulative revision rate of 0.3 (0.0, 2.5) at 1 year, which is a lower rate of revision compared to MoM resurfacing combinations at 1 year (AOA NJRR Annual Report 2022 Page 159 Table HT94).2 According to the AOA NJRR Annual Report 2022, of all the revisions for total hip resurfacing procedures, the most common reasons were loosening, metal related pathology and (periprosthetic) fracture.

The NZJR also provides information on resurfacing components. The use of MoM-resurfacing continuously increased from 70 procedures in 2016 to 122 procedures in 2020, however only 77 new resurfacing procedures were recorded in 2021.5

Download the full issue

Download the CeraNews issue 1/2023 including the article “PROMS: Evaluating Health Gains and Patient Satisfaction” as a PDF.

Issue #1 2023: Insights from Hip Registries: the Continued Rise of Ceramic in Clinical Use
3 MB, pdf
Abbreviations, Tables and Figures

AJRR: The American Joint Replacement Registry

AOA NJRR: The Australian Orthopaedic Association National Joint Replacement Registry 

CI: Confidence Interval

CMoP: Ceramicised Metal-on-Polyethylene

CoC: Ceramic-on-Ceramic 

CoM: Ceramic-on-Metal

CoP: Ceramic-on-Polyethylene (including both conventional polyethylene and cross-linked polyethylene)

CoPoM: Ceramic-on-Polyethylene-on-Metal (Dual Mobility - only used by the NJR) 

CoXLPE: Ceramic-on-Cross-Linked Polyethylene

CohXLPE: Ceramic-on-Highly Cross-Linked Polyethylene (only used by the EPRD)

DM: Dual Mobility

EPRD: Endoprothesenregister Deutschland (The German Arthroplasty Registry)

EQ-5D: European Quality of Life 5 Dimensions

EQ-5D-5L: European Quality of Life 5 Dimensions 5 Level Version

EQ VAS Health: EuroQol-Visual Analogue Scales

HOOS JR. Score: Hip Disability and Osteoarthritis Outcome Score for Joint Replacement Score

HR: Hazard Ratio

ISAR: International Society of Arthroplasty Registries 

MoM: Metal-on-Metal

MoP: Metal-on-Polyethylene (including both conventional polyethylene and cross-linked polyethylene)

MoPoM: Metal-on-Polyethylene-on-Metal (Dual Mobility - only used by the NJR)

MoXLPE: Metal-on-Cross-Linked Polyethylene

MohXLPE: Metal-on-Highly Cross-Linked Polyethylene (only used by the EPRD)

NHS: The National Health Service

NJR: The National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and the States
of Guernsey

NZJR: The New Zealand Joint Registry

OA: Osteoarthritis

PROMs: Patient-Reported Outcome Measures

PROMIS-10: Patient-Reported Outcomes Measurement Information System-10

SAR: The Swedish Arthroplasty Register (Merger of the Swedish Hip Arthroplasty Register and the Swedish Knee Arthroplasty Register)

SD: Standard Deviation

THA: Total Hip Arthroplasty

THR: Total Hip Replacement

VR-12: The Veterans RAND 12 Item Health Survey


1. National Joint Registry. 19th Annual Report 2022. Surgical data to 31 December 2021. ISSN:2054-183X (Online) 2022:1-374.

2. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2022 Annual Report, Adelaide; AOA, 2022:1-487. Accessed from: https://aoanjrr.sahmri.com/annual-reports-2022

3. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2022. Mit Sicherheit mehr Qualität. ISBN:978-3-949872-00-6 2022:1-175.

4. American Joint Replacement Registry (AJRR): 2022 Annual Report. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS), 2022.

5. The New Zealand Joint Registry. Twenty-three year report January 1999 to December 2021. 2022:1-237.

6. Swedish Arthroplasty Register. Annual report 2022. ISSN:1654-5982 2022:1-267.

7. Dutch Arthroplasty Register (LROI). Online LROI annual report 2022. Joint arthroplasty data to 31 December 2021. 2022:1-214.

8. Endoprothesenregister Deutschland (EPRD). Statusbericht 2014 Mit Sicherheit mehr Qualität. ISBN:978-3-9817673-
0-8. 2015:1-60.

9. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2015 Mit Sicherheit mehr Qualität. ISBN:978-3-9817673-
1-5. 2016:1-65.

10. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2016 Mit Sicherheit mehr Qualität. ISBN:978-3-9817673-2-2. 2017:1-64.

11. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2017 Mit Sicherheit mehr Qualität. ISBN:978-3-9817673-3-9. 2018:1-80.

12. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2019 Mit Sicherheit mehr Qualität. ISBN: 978-3-9817673-4-6. 2020: 1-125.

13. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2020 Mit Sicherheit mehr Qualität. ISBN: 978-3-9817673-6-0. 2020: 1-132.

14. Endoprothesenregister Deutschland (EPRD). Jahresbericht 2021 Mit Sicherheit mehr Qualität. ISBN:978-3-9817673-9-1 2021:1-193.