158 Fig. 3 WOMAC pre- and post-operative results mostly dedicated to the social and psychological arena [21]. Utilization of these QoL indicators alongside more traditional evaluation instruments, such as the Harris hip score, continues to increase in the literature [14, 20]. Orthopedic surgeons may wish to address clinical decision-making from not only physical and radiologic ﬁndings but also the context of QoL: the timing of an operation can, for example, be delayed until any attendant psychological or social concerns are addressed. That being said, quality of life evaluations should neither replace clinical and radiographic examination nor be used inde- pendently as the basis for a surgical indication [19]. Quality of life evaluation may help with the qualitative determination of the patient’s motivations and expectations for joint replacement. QoL questionnaires can also be used for patient follow-up and satisfaction, either alone or in concert with other surveys [7, 8, 22–24]. Conﬂict of interest statement The authors had no competing interests, ﬁnancial or otherwise, in the development of the study. References 1. The WHOQOL Group (1998) The World Health Organization Quality of Life Assessment (WHOQOL): development and gen- eral psychometric properties. Soc Sci Med 46(12):1569–1585 2. De Girolamo G, Rucci P, Scocco P, Becchi A, Coppa F, D’Addario A, Daru` E, De Leo D, Galassi L, Mangelli L, Marson C, Neri G, Soldani L (2000) Quality of life evaluation: validity of short-WHOQOL. Epidemiol Psichiatr Soc 9(1):45–55 (Italian) 3. Ware JE, Keller SD, Gandek B, Brazier JE, IQOLA Sullivan M, Group Project (1995) Evaluating translation of health status questionnaires: methods from the IQOLA Project. Int J Technol Assess Health Care 11:525–551 4. Apolone G, Cifani S, Mosconi P (1997) SF-36 health question- naire. Translation and validity of Italian version: IQOLA project results. Medic 2:86–94 5. Apolone G, Mosconi P, Ware JE (1997) SF-36 health question- naire. Manual for use and guide to interpreting the results. Guerini e Associati, Milan, Italy 123 J Orthopaed Traumatol (2008) 9:155–158 6. Bellamy N (2005) The WOMAC knee and hip osteoarthritis indices: development, validation, globalization and inﬂuence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol 23(Suppl 39):148–153 7. Bellamy N, Buchanan W, Goldsmith C, Campbell J, Stitt L (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to anti-rheumatic drug therapy in patient with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840 8. Salafﬁ F, Carotti M, Grassi W (2005) Health-related quality of life in patient with hip or knee osteoarthritis: comparison of generic and disease-speciﬁc instruments. Clin Rheumatol 24:29–37 9. Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Centre, Boston, MA 10. Bellamy N (2008) WOMAC 3.1 index webpage. http://www. auscan.org/womac/index.htm. Last accessed 27 July 2008 11. Ostendorf M, Van Stel HF, Buskens E, Schrijvers JP, Marting LN, Verbout AJ, Dhert WJA (2004) Patient-reported outcome in total hip replacemet. A comparison of ﬁve instruments of health status. J Bone Joint Surg Br 86:801–808 12. McGrory J, Shinar AA, Freiberg AA, Harris WH (1997) Enhancement of the value of hip questionnaires by telephone follow-up evaluation. J Arthroplasty 12(3):340–343 13. Bachmeier CJM, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG, Brooks PM (2001) A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage 9:137–146 14. Lieberman JR, Dorey F, Shekelle P, Schumacher L, Kilgus DJ, Thomas BJ, Finerman GA (1997) Outcome after total hip arthro- plasty. Comparison of a traditional disease-speciﬁc and quality-of- life measurement of outcome. J Arthroplasty 6:639–645 15. Johanson NA, Liang MH, Daltroy L, Rudicel S, Richmond J (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sen- sitivity to change. J Bone Joint Surg Am 86A:902–909 16. Kelly KD, Kramer G, Johnston DWC, Redfern L, Suarez- Almazor ME (2000) The impact of health status on waiting time for major joint arthroplasty. J Arthroplasty 15(7):877–883 17. Kelly KD, Voaklander DC, Johnston DWC, Newman SC, Suarez- Almazor ME (2001) Change in pain and function while waiting for major joint arthroplasty. J Arthroplasty 16(3):351–359 18. Padua R, Romanini E, Gillio A, Bond`ı R, Ceccarelli E, Campi S, Pecorelli F (2005) Health-related quality of life after hip ra- placement. J Orthop Traumatol 6:10–14 19. McGuigan FX, Hozack WJ, Moriarty L, Eng K, Rothman RH (1995) Predicting quality-of-life outcomes following total joint arthroplasty. Limitation of the SF-36 health status questionnaire. J Arthroplasty 10(6):742–747 20. Chiu HC, Mau LW, Hsu YC, Chang JK (2001) Postoperative 6- month and 1-year evaluation of health-related quality of life in total hip replacement patient. J Formos Med Assoc 100(7):461– 465 21. Wright JG (1997) A comparison of different indices of respon- siveness. J Clin Epidemiol 50(3):239–246 22. Dawson J, Linsell L, Zondervan K, Rose P, Randall T, Carr A, Fitzpatrick R (2004) Epidemiology of hip and knee pain and its impact on overall health status in older adults. Rheumatology 43:497–504 23. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthro- plasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974 25. Villani C, Romanini E, Giordano MC, Persiani P, Casella F (2000) Uncemented total hip prosthesis: patient’s middle term follow-up evaluation. GIOT 26:67–73