Comparison between OECD countries – a Finnish hospital achieves a top international score in terms of the effectiveness of joint replacement surgery

28.11.2019 — Joint replacement surgery news

Led by a Canadian workgroup, the OECD project confirmed the international standards for measuring the effectiveness of joint replacement surgery. At the same time, the effectiveness of hip and knee joint replacement surgery at various hospitals was compared on the basis of patient assessments. Finland’s representative in the project, Coxa Hospital for Joint Replacement, achieved outcomes that topped the international comparison.

Outcomes were collected from eight countries. The materials used in the comparison were the Oxford Knee and Hip Score patient-reported outcome measures.

From each country, the project only accepted hospitals or national quality registries that had comprehensively collected data on the effectiveness of joint replacement surgery over a sufficiently long period of time. The only Finnish hospital to meet the criteria was Coxa Hospital for Joint Replacement.

Of course, it was good to know that our outcomes are in line with any international actor, but what’s even more important is the fact that the effectiveness is measured from the patient’s perspective and that international measurement standards were now agreed on,” says Antti Eskelinen, Research Director at Coxa Hospital for Joint Replacement.

The patient’s assessment becoming more important than the doctor’s

Traditionally, the doctor’s opinion has been emphasized in assessing the success of operations. Over the past decade, this has changed in many countries, and the patient’s opinion is now prioritised. The patient’s subjective assessment, carried out independent of the medical staff, sometimes differs from the surgeon’s assessment.

If the patient personally thinks that their knee does not work well after the operation, the goal has not been reached, even if an X-ray taken after the operation looks fine. While the patient-oriented measurement of effectiveness is gaining ground, it is still very rare in Finland compared to countries such as Sweden, the Netherlands and England,” Antti Eskelinen says.

The OECD project agreed on common methods for measuring the effectiveness of knee and hip joint replacement surgery. The methods chosen were the Oxford Knee and Hip Score patient-reported outcome measures, which were developed at Oxford University, England, as the name suggests.

Open effectiveness measurement benefits the patient and the hospital

The Oxford Score measure is based on a validated, easy-to-complete questionnaire with 12 standard questions, whose results are converted to scores. The questionnaire is completed before the operation as well as 2–3 and 12 months after it. Among other things, the questions address the patient’s experience of pain and functional capacity.

Research Director Antti Eskelinen finds it important to increase the comparison of the effectiveness of treatment outcomes between hospitals in Finland.

Since hospitals are publicly funded, they should also be able to publish information on the effects of their operations. Open comparison helps hospitals improve their activities and provides patients with criteria for assessing and choosing their place of treatment,” he says.

Standardising the effectiveness measurement of joint replacement surgery and comparing the effectiveness outcomes from different countries was part of the OECD’s new, extensive Health at a Glance 2019 project, which comprehensively dealt with the residents’ health of the 36 member states. This was not scientific research but rather an international pilot comparison.

The pilot comparison involved hospitals and quality registries from the following countries: England, the Netherlands, Sweden, Canada, Switzerland, Australia, Finland and Italy.

The full report:

Health at a Glance 2019: OECD Indicators



Pilot comparison of the effectiveness of joint replacement surgery in the OECD’s Health at a Glance 2019 report: Part 6. QUALITY AND OUTCOMES OF CARE, Hip and knee surgery:
– Page 2 of the appendix, figures 6.21 and 6.22 (left column), Oxford Hip Score and Oxford Knee Score.