Many fields are derived from the existing NJR. John Timperley MB ChB FRCS (Ed) DPhil (Oxon) Vice President British Hip Society
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1 Minimum Dataset for BHS Non Arthropasty Hip Surgery Database Please note: Many fields are derived from the existing NJR John Timperley MB ChB FRCS (Ed) DPhil (Oxon) Vice President British Hip Society 1 PATIENT DETAILS * PATIENT HOSPITAL ID: * FORENAME: * SURNAME: * GENDER 1 MALE 2 FEMALE 3 NOT KNOWN 4 NOT SPECIFIED * DATE OF BIRTH DD/MM/YYYY * PATIENT POSTCODE NHS NUMBER * PATIENT CONSENT OBTAINED 1 YES 2 NO 3 NOT RECORDED - Patient e- mail address*: 2 OPERATION DETAILS * HOSPITAL: * OPERATION DATE: DD/MM/YYYY * OPERATION FUNDING 1 NHS 1 INDEPENDENT 3 SURGEON DETAILS * CONSULTANT IN CHARGE: * OPERATING SURGEON: 4. Patient: Clinical situation leading to procedure (tick all that apply): 1. Unknown: Diagnostic* 2. Developmental abnormality: acetabulum* femur*
2 3. FAI: Type: Cam* Pincer* Mixed* 2. Central compartment Labral pathology* Osteochondral defect/pathology* Loose body* Ligametum teres* 3. Extra- articular pathology: Bursae* Iliopsoas* Ilio- tibial band* External rotators* Sciatic nerve* 5. Other diagnoses (same as for NJR) 5 HIP OPERATION DETAILS * SIDE: 1 LEFT 2 RIGHT * Other diagnoses (SELECT ALL THAT APPLY) 1 OSTEOARTHRITIS 2 ANKYLOSING SPONDYLITIS 3 AVASCULAR NECROSIS 4 CONGENITAL DISLOCATION/ DYSPLASIA OF THE HIP 5 FAILED HEMI-ARTHROPLASTY 6 FAILED INTERNAL FIXATION 7 FRACTURED ACETABULUM 8 FRACTURED NECK OF FEMUR 9 OTHER HIP TRAUMA 10 OTHER INFLAMMATORY ARTHROPATHY 11 PERTHES 12 PREVIOUS ARTHRODESIS 13 PREVIOUS INFECTION 14 PSORIATIC ARTHROPATHY 15 SEROPOSITIVE RHEUMATOID ARTHRITIS 16 SLIPPED UPPER FEMORAL EPIPHYSIS 17 OTHER
3 6. Severity of osteoarthritis (Tonnis)* 7. Investigations available: XR* MR arthrogram* MRI* CT* 3- D CT* EOS* Previous arthroscopy (no: )* Measurements: Acetabular anteversion* Femoral anteversion* Alpha Angle* 8. PROMS data: MAHORN Hip Outcome Tool (MHOT14) Quality of Life Questionnaire for Young, Active Patients with Hip Problems. Each score is numerical (0-100) SYMPTOMS AND FUNCTIONAL LIMITATIONS 1. How difficult is it for you to walk long distances? * 2. How difficult is it for you to get up and down off the floor/ground? * 3. How difficult is it for you to lie on your affected hip side?* 4. How much trouble do you have with grinding, catching or clicking in your hip? * 5. Overall, how much pain do you have in your hip/groin?* II: SPORTS AND RECREATIONAL ACTIVITIES 6. How concerned are you about your ability to maintain your desired fitness level? * 7. How much pain do you experience in your hip after activity?* 8. How concerned are you about cutting/changing directions during your sport or recreational activities?* III: JOB RELATED CONCERNS 9. How much trouble do you have pushing, pulling, lifting or carrying heavy
4 objects at work?* 10. How much difficulty do you have at work because of reduced hip mobility?* IV: SOCIAL, EMOTIONAL AND LIFESTYLE CONCERNS 11. How much trouble do you have with sexual activity because of your hip?* 12. How much of a distraction is your hip problem? * 13. How concerned are you about picking up or carrying children because of your hip? * 14. How much of the time are you aware of the disability in your hip?* EQ 5- D* Gen heath %* Details of surgery (indicate all appropriate): Approach: Open: Mini- open* Surgical Hip Dislocation* Arthroscopic* Traction time*
5 1) acetabular work labral debridement* labral repair* rim recession and labral re- attachment* isolated rim recession* chondral treatment* chondral grafting* 2) Peripheral compartment work osteochondroplasty* removal of loose bodies* other* 3) extra- articular work * Incision* Debridement* Repair* 4) Pelvic osteotomy Type: Chiari* PAO* TPO * Other (State)* 5) Femoral osteotomy Type: Rotation* valgus* varus* shortening*
6 Complications:* Other information: Text* complex (e.g. double femoral osteotomy)* Draft AJT Contributors: Timperley, Haddad, Witt, Griffin, O Hara, Wilson, Hodgkinson., Ramachandran, Fern, Bannister, Field, Happy with content: Gundle, Wynn- Jones, Clayson,
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