Total Hip Arthroplasty (THA) remains a cornerstone procedure in orthopedic surgery for managing advanced hip joint pathology such as osteoarthritis, rheumatoid arthritis, and traumatic joint damage. With ongoing advancements in surgical technique and implant technology, the integration of Patient-Reported Outcome Measures (PROMs) into clinical practice has become essential for optimizing patient care and surgical outcomes.
Importance of Integrating PROMs into THA Practice
1. Enhancing Patient-Centered Care and Communication
PROMs help physicians move beyond the traditional biomedical model, incorporating the patient’s voice as a core element of care. Routine use of PROMs encourages open dialogue about pain management, functional goals, and lifestyle impact, fostering a more collaborative physician-patient relationship.
2. Objective Measurement of Functional Outcomes Over Time
Collecting PROMs longitudinally — preoperatively, early postoperative, and at long-term follow-up — allows surgeons to track recovery patterns, measure treatment effectiveness, and adjust interventions. This longitudinal data supports evidence-based practice and personalized rehabilitation adjustments.
3. Early Detection of Postoperative Complications and Suboptimal Outcomes
Changes or deterioration in PROM scores post-surgery may signal complications such as infection, prosthesis loosening, or persistent pain syndromes. Prompt recognition through PROM monitoring enables timely clinical evaluation and intervention.
4. Benchmarking and Quality Improvement
Aggregated PROMs data across patient cohorts provides robust benchmarks for surgeon performance, implant comparisons, and institutional quality assurance. This data drives continuous improvement, supports clinical audit, and aligns with regulatory and payer reporting requirements.
5. Supporting Shared Decision-Making
Access to PROMs outcomes helps clinicians counsel patients more effectively about expected pain relief, functional gains, and rehabilitation timelines. It empowers patients to weigh surgical risks and benefits, enhancing satisfaction and adherence to postoperative protocols.
Examples of PROMs in Total Hip Arthroplasty (THA): Clinical Overview
In THA, it is common to use several different PROMs to capture a holistic image of patient health and well-being before, during, and after surgery.
1. Oxford Hip Score (OHS)
The Oxford Hip Score is a concise, 12-item questionnaire focused on pain and functioning specifically related to hip pathology.
Domains:
Pain intensity
Functional mobility (walking, stair climbing, getting in/out of vehicles)
Clinical Utility and Application: The OHS is highly sensitive to clinical change, making it practical for monitoring patient status pre- and post-THA. Straightforward scoring aids in quick clinical interpretation. It is primarily used in elective THA and revision surgery to quantify patient-reported pain and function, facilitating preoperative assessment and postoperative monitoring.
2. Harris Hip Score (HHS)
The HHS integrates patient-reported symptoms with objective clinician assessments of hip function, deformity, and range of motion.
Domains:
Pain intensity and frequency
Functional activities including gait and daily living
Physical deformity and range of motion evaluation
Psychometric Strengths:
Comprehensive tool widely adopted in clinical research and practice
Balances subjective and objective measures for a full clinical picture
3. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
WOMAC is a disease-specific instrument designed to evaluate pain, stiffness, and physical function in osteoarthritis affecting hips and knees.
Domains:
Pain during various physical activities
Joint stiffness duration and severity
Difficulty in daily physical function tasks
Psychometric Strengths:
Highly responsive to clinical changes post-arthroplasty
Validated internationally with strong reliability
4. SF-36 Health Survey
The SF-36 is a generic PROM assessing broad health-related quality of life across multiple physical, emotional, and social domains.
Domains:
Physical functioning and role limitations
Emotional well-being and mental health
Social functioning and vitality
General health perceptions and pain
Psychometric Strengths:
Widely used in diverse clinical populations for cross-condition comparison
Provides normative data for benchmarking patient status relative to the general population
Clinical Utility and Application: Valuable for assessing the overall impact of THA on general health and quality of life beyond hip-specific symptoms, supporting holistic patient care.
Oxford Hip Score (OHS)
A concise 12-item questionnaire focused on pain and functional mobility (walking, stairs, vehicles).
Highly sensitive to clinical change; practical for pre- and post-THA monitoring.
Learn More →Harris Hip Score (HHS)
Combines patient symptoms with clinician assessments of pain, function, deformity, and motion.
Comprehensive tool for detailed post-op evaluation and functional recovery monitoring.
Learn More →WOMAC
Disease-specific measure for pain, stiffness, and function in osteoarthritis of hips and knees.
Highly responsive and internationally validated; ideal for pre-op and long-term monitoring.
SF-36 Health Survey
Generic survey assessing physical, emotional, social health and overall quality of life.
Supports holistic patient care with normative data and broad health comparisons.
Best Practices for Implementing PROMs in Orthopedic Clinical Workflow
Select the Right PROMs
Choose PROMs validated for THA that capture relevant patient outcomes without overburdening patients or clinicians.
Streamline Collection with Digital Tools
Utilize platforms like UNITY to automate PROMs administration, reminders, and real-time data capture for seamless workflow integration.
Interpret & Apply PROMs Data
Train clinical teams to analyze PROMs insights to inform personalized care decisions and monitor recovery progress.
Provide Automated Delivery & Reminders
Provide automated delivery of PROMs and reminder notifications at pre-defined intervals to boost patient participation and data quality.
The Future of PROMs in THA: Digital Integration and Personalized Orthopedic Care
Digital health technologies are transforming PROMs collection and utilization:
Mobile health applications enable real-time symptom tracking and remote monitoring.
Wearable sensors complement PROMs by providing objective functional data.
Telemedicine platforms facilitate ongoing PROMs follow-up without in-person visits.
Integration of these technologies supports personalized medicine by enabling dynamic adjustment of treatment plans based on patient-reported and sensor-derived data, potentially improving recovery speed and reducing complications.
Conclusion
For orthopedic surgeons and clinical teams, Patient-Reported Outcome Measures (PROMs) represent an indispensable addition to the Total Hip Arthroplasty care pathway. They provide critical insight into patient experience, functional recovery, and quality of life — dimensions essential for truly patient-centered care. Incorporating PROMs into routine clinical practice enhances decision-making, enables early detection of complications, supports continuous quality improvement, and aligns with evolving value-based healthcare models.