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Okamoto Y, Wakama H, Nakamura K, Ishitani T, Otsuki S, Neo M. Worse Patient-Reported Outcomes and Spino-Pelvic Parameters After Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis of the Hip Compared to Osteoarthritis: A Propensity-Matched Cohort Study. J Arthroplasty 2024; 39:2303-2310. [PMID: 38608844 DOI: 10.1016/j.arth.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND This study aimed to assess the association between the disease process of hip osteoarthritis and total hip arthroplasty (THA) outcomes; this is a critical issue, as rapid progression has been postulated to be responsible for patient dissatisfaction after THA. METHODS This retrospective case-control study included 255 patients who underwent THA and completed a mean follow-up duration of 42.1 months (range, 24.0 to 77.0). We classified patients into those who had (n = 26) and did not have (n = 229) rapidly progressive osteoarthritis of the hip (RPOA), defined as a narrowing rate of joint space ≥ 2 mm yearly or a ≥ 50% loss within 12 months, excluding any other cause of a destructive arthropathy. Propensity score-matched cohorts for age, sex, body mass index, and spino-pelvic measures were created, and the outcomes were compared between the 2 groups. RESULTS After successfully matching RPOA (n = 25) and non-RPOA patients (n = 50), there were significant differences in minimum clinically important difference (P = .009 for European Quality of Life 5-Dimension, and P < .001 for low back pain), patient acceptable symptom state (P = .015 for European Quality of Life 5-Dimension, and P < .001 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement score), patient satisfaction (P = .028), and T1 pelvic angle as an indicator of global sagittal spinal deformity (P = .017). There was a correlation between T1 pelvic angle and low back pain in the RPOA group (R = 0.628, P < .001). CONCLUSIONS Patients who exhibited RPOA before undergoing THA showed worse patient-reported outcomes compared with those who did not have rapid progression. Our study highlights the critical role of the disease process in influencing THA outcomes, advocating for a paradigm shift toward more meticulous preoperative evaluations, including global spinal deformity, standardized diagnostic criteria, and tailored interventions.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, Ibaraki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Matsuyama J, Okamoto Y, Wakama H, Nakamura K, Saika T, Otsuki S, Neo M. Factors associated with the progression of sagittal spinal deformity after total hip arthroplasty: a propensity score-matched cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1953-1961. [PMID: 38589707 DOI: 10.1007/s00264-024-06174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The functional interaction between the hip and spine in patients undergoing total hip arthroplasty (THA) is clinically significant, as it impacts post-operative outcomes. Therefore, this study aimed to identify factors associated with the progression of sagittal spinal deformity and assess the association with patient-reported outcomes. METHODS This retrospective case-control study included 200 patients who underwent primary THA and completed a mean follow-up duration of 42.2 months (range, 24.0-78.0). We employed a multivariate logistic regression to identify variables predictive of a post-THA sagittal vertical axis (SVA) ≥ 50 mm, which was indicative of a spinal sagittal imbalance. Propensity score-matched cohorts for age, sex, body mass index, follow-up duration, hip flexion contracture, developmental dysplasia, pelvic incidence (PI), and SVA were created, and the outcomes were compared between the two groups. RESULTS PI (odds ratio 1.39; 95% confidence interval 1.04-1.86, p = 0.033) was associated with an SVA ≥ 50 mm. After successfully matching patients with (n = 50) and without (n = 50) an SVA ≥ 50 mm, the minimum clinically important difference showed significant differences between the 50 matched pairs (p = 0.016 for EuroQol-5D, p = 0.003 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement, and p < 0.001 for low back pain). CONCLUSION PI is associated with the development of a positive sagittal spinal malalignment post-THA. This finding can assist surgeons in managing patient expectations and in optimising outcomes. Feasible strategies are warranted to minimise the risk of spinal deformity progression post-THA.
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Affiliation(s)
- Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan.
- Department of Orthopedic Surgery, Saiseikai Ibaraki Hospital, 2-1-45, Mitsukeyama, Ibaraki, 567-0035, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Takafumi Saika
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
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Emara AK, Pasqualini I, Jin Y, Klika AK, Orr MN, Rullán PJ, Piuzzi NS. What Are the Diagnosis-Specific Thresholds of Minimal Clinically Important Difference and Patient Acceptable Symptom State in Hip Disability and Osteoarthritis Outcome Score After Primary Total Hip Arthroplasty? J Arthroplasty 2024; 39:1783-1788.e2. [PMID: 38331359 DOI: 10.1016/j.arth.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND This study aimed to determine the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds for Hip Disability and Osteoarthritis Outcome Score (HOOS) pain, physical short form (PS), and joint replacement (JR) 1 year after primary total hip arthroplasty stratified by preoperative diagnosis of osteoarthritis (OA) versus non-OA. METHODS A prospective institutional cohort of 5,887 patients who underwent primary total hip arthroplasty (January 2016 to December 2018) was included. There were 4,184 patients (77.0%) who completed a one-year follow-up. Demographics, comorbidities, and baseline and one-year HOOS pain, PS, and JR scores were recorded. Patients were stratified by preoperative diagnosis: OA or non-OA. Minimal detectable change (MDC) and MCIDs were estimated using a distribution-based approach. The PASS values were estimated using an anchor-based approach, which corresponded to a response to a satisfaction question at one year post surgery. RESULTS The MCID thresholds were slightly higher in the non-OA cohort versus OA patients. (HOOS-Pain: OA: 8.35 versus non-OA: 8.85 points; HOOS-PS: OA: 9.47 versus non-OA: 9.90 points; and HOOS-JR: OA: 7.76 versus non-OA: 8.46 points). Similarly, all MDC thresholds were consistently higher in the non-OA cohort compared to OA patients. The OA cohort exhibited similar or higher PASS thresholds compared to the non-OA cohort for HOOS-Pain (OA: ≥80.6 versus non-OA: ≥77.5 points), HOOS-PS (OA: ≥83.6 versus non-OA: ≥83.6 points), and HOOS-JR (OA: ≥76.8 versus non-OA: ≥73.5 points). A similar percentage of patients achieved MCID and PASS thresholds regardless of preoperative diagnosis. CONCLUSIONS While MCID and MDC thresholds for all HOOS subdomains were slightly higher among non-OA than OA patients, PASS thresholds for HOOS pain and JR were slightly higher in the OA group. The absolute magnitude of the difference in these thresholds may not be sufficient to cause major clinical differences. However, these subtle differences may have a significant impact when used as indicators of operative success in a population setting.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Yuxuan Jin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Melissa N Orr
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Kiadaliri A, Cronström A, Dahlberg LE, Lohmander LS. Patient acceptable symptom state and treatment failure threshold values for work productivity and activity Impairment and EQ-5D-5L in osteoarthritis. Qual Life Res 2024; 33:1257-1266. [PMID: 38409279 PMCID: PMC11045603 DOI: 10.1007/s11136-024-03602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To estimate patient acceptable symptom state (PASS) and treatment failure (TF) threshold values for Work Productivity and Activity Impairment (WPAI) measure and EQ-5D-5L among people with hip or knee osteoarthritis (OA) 3 and 12 months following participation in a digital self-management intervention (Joint Academy®). METHODS Among the participants, we computed work and activity impairments scores (both 0-100, with a higher value reflecting higher impairment) and the Swedish hypothetical- (range: - 0.314 to 1) and experience-based (range: 0.243-0.976) EQ-5D-5L index scores (a higher score indicates better health status) at 3- (n = 14,607) and 12-month (n = 2707) follow-ups. Threshold values for PASS and TF were calculated using anchor-based adjusted predictive modeling. We also explored the baseline dependency of threshold values according to pain severity at baseline. RESULTS Around 42.0% and 48.3% of the participants rated their current state as acceptable, while 4.2% and 2.8% considered the treatment had failed at 3 and 12 months, respectively. The 3-month PASS/TF thresholds were 16/29 (work impairment), 26/50 (activity impairment), 0.92/0.77 (hypothetical EQ-5D-5L), and 0.87/0.77 (the experience-based EQ-5D-5L). The thresholds at 12 months were generally comparable to those estimated at 3 months. There were baseline dependencies in PASS/TF thresholds with participants with more severe baseline pain considering poorer (more severe) level of WPAI/EQ-5D-5L as satisfactory. CONCLUSION PASS and TF threshold values for WPAI and EQ-5D-5L might be useful for meaningful interpretation of these measures among people with OA. The observed baseline dependency of estimated thresholds limits their generalizability and values should be applied with great caution in other settings/populations.
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Affiliation(s)
- Ali Kiadaliri
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
- Arthro Therapeutics, Malmö, Sweden.
- Clinical Epidemiology Unit, Skåne University Hospital, Remissgatan 4, 221 85, Lund, Sweden.
| | - Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
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Sato EH, Treu EA, Froerer DL, Zhang C, O’Neill DC, Cizik AM, Haller JM. Establishing the Patient Acceptable Symptom State Thresholds for Patient-Reported Outcomes after Operatively Treated Tibial Plateau Fractures. J Orthop Trauma 2024; 38:121-128. [PMID: 38117573 PMCID: PMC11330326 DOI: 10.1097/bot.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Define patient-acceptable symptom state (PASS) thresholds and factors affecting PASS thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) following operatively treated tibial plateau fractures. METHODS DESIGN Retrospective cohort. SETTING Single Level I academic trauma center. PATIENT SELECTION CRITERIA All patients (n = 159) who underwent fixation of a tibial plateau fracture from 2016 to 2021 and completed patient-reported outcome measures (PROMs) at minimum 1-year follow-up were enrolled for the study. OUTCOME MEASURES AND COMPARISONS PASS thresholds for global outcome (PASS-Global), pain (PASS-Pain), and function (PASS-Function) were determined using anchor-based questions such as "How satisfied are you today with your injured lower extremity?" with answer choices of very satisfied, satisfied, neutral, unsatisfied, and very unsatisfied. PASS thresholds for each PROM were calculated using 3 methods: (1) 80% specificity, (2) 75th percentile, and (3) Youden Index. RESULTS Sixty percent of patients were satisfied with their global outcome and 53% with function. Using 80% specificity, 75th percentile, and Youden Index, PASS-Global thresholds were 48.5, 44.5, and 47.9 for PROMIS-PF and 56.3, 56.2, and 56.3 for KOOS-QOL, respectively. PASS-Pain threshold for KOOS-Pain was 84.4, 80.6, and 80.6, respectively. PASS-Function thresholds were 48.9, 46.8, and 48 for PROMIS-PF and 94.1, 90.2, and 86.8 for KOOS-ADL, respectively. Younger patients and those with bicondylar fractures or infections were associated with significantly lower PASS-Pain thresholds. Schatzker II fractures, lateral column involvement, or isolated lateral approach resulted in significantly higher PASS-Global and PASS-Function thresholds. CONCLUSIONS This study defines global, functional, and pain PASS thresholds for tibial plateau fractures. Patients with bicondylar fractures, infections, and medial column involvement were more often unsatisfied. These thresholds are valuable references to identify patients who have attained satisfactory outcomes and to counsel patients with risk factors for unsatisfactory outcomes following tibial plateau fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eleanor H. Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Emily A. Treu
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Devin L. Froerer
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Dillon C. O’Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Amy M. Cizik
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Justin M. Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Kokubu Y, Fujiwara T, Matsumoto Y, Endo M, Setsu N, Iida K, Nabeshima A, Nakashima Y. Older age at surgery and postoperative leg length discrepancy are risk factors for unfavourable patient-reported outcome measures of knee tumour endoprostheses following resection for musculoskeletal tumour of the lower limb. Bone Jt Open 2023; 4:906-913. [PMID: 38035606 PMCID: PMC10694779 DOI: 10.1302/2633-1462.412.bjo-2023-0125.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Aims To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. Methods The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated. Results The thresholds for favourable TESS and COMMON were 64.8 and 70.4 points, respectively. Multivariate analysis showed that age at surgery (p = 0.004) and postoperative leg length discrepancy (p = 0.043) were significant risk factors for unfavourable TESS results, while age at surgery (p < 0.001) was a significant risk factor for unfavourable COMMON-LE results. Following receiver operating characteristic analysis, the threshold for both TESS and COMMON-LE was 29 years of age at surgery. Additionally, a leg length discrepancy of 8.2 mm was the threshold for unfavourable TESS. Conclusion Patients aged > 29 years at the time of surgery require appropriate preoperative counselling and adequate postoperative physical and socioemotional support. Reconstruction equivalent to the length of the resected bone can reduce the risk of functional disabilities in daily living.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sato EH, Stevenson KL, Blackburn BE, Peters C, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00358-3. [PMID: 37068568 DOI: 10.1016/j.arth.2023.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. METHODS Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement (HOOS-JR) and EuroQol-5 dimension (EQ5D). Physical activity was recorded on a wearable technology. Data was collected pre-operatively and at one, three, six, and twelve months post-operatively. Generalized estimating equations were used to evaluate outcomes over time. RESULTS Significant improvement occurred between pre- and post-operative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month post-operatively, each improving by at least one minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least one MCID (three months and one year, respectively). Gait speed and walking asymmetry returned to baseline by three months, but did not reach a MCID of improvement by one-year. CONCLUSION Patients can be counseled that the greatest proportional improvement in PROMs is within one month after THA, while function surpasses pre-operative baselines by three-months, and gait quality may not improve until after one-year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
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Affiliation(s)
- Eleanor H Sato
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Brenna E Blackburn
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher Peters
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael J Archibeck
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher E Pelt
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lucas A Anderson
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Noseworthy TW. Patient acceptable symptom state (PASS): thresholds for the EQ-5D-5L and Oxford hip and knee scores for patients with total hip and knee replacement. Qual Life Res 2023; 32:519-530. [PMID: 36367656 DOI: 10.1007/s11136-022-03287-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To define patient acceptable symptom state (PASS) cut-off values for the EQ-5D-5L and Oxford hip (OHS) and knee (OKS) scores 6 and 12 months after total hip (THR) or knee (TKR) replacement. To compare PASS cut-off values for the EQ-5D-5L scored using: (1) the Canadian value set, (2) the crosswalk value set, and (3) the equal weighted Level Sum Score (LSS). METHODS We mailed questionnaires to consecutive patients following surgeon referral for primary THR or TKR and at 6 and 12 months post-surgery. Patient reported outcome measures (PROMs) were the EQ-5D-5L, the OHS, and OKS. We assessed PASS cut-off values for PROMs using percentile and ROC methods, with the Youden Index. RESULTS Five hundred forty-two surgical patients (mean age, 64 years, 57% female, 49% THR) completed baseline and 12-month questionnaires. 89% of THR and 81% of TKR patients rated PASS as acceptable at 12 months. PASS cut-off values for THR for the EQ-5D-5L (Canadian) were 0.85 (percentile) and 0.84 (Youden) at 12 months. Cut-off values were similar for the LSS (0.85 and 0.85) and lower for the crosswalk value set (0.74 and 0.73), respectively. EQ-5D-5L cut-off values for TKR were Canadian, 0.77 (Percentile) and 0.78 (Youden), LSS, 0.75 and 0.80, and crosswalk, 0.67 and 0.74, respectively. Cut-off values 6 and 12 months post-surgery ranged from 38 to 39 for the OHS, and 28 to 36 for the OKS (range 0 worst to 48 best). CONCLUSION PASS cut-off values for the EQ-5D-5L and Oxford scores varied, not only between methods and timing of assessment, but also by different EQ-5D-5L value sets, which vary between countries. Because of this variation, PASS cut-off values are not necessarily generalizable to other populations of TJR patients. We advise caution in interpreting PROMs when using EQ-5D-5L PASS cut-off values developed in different countries. A standardization of methods is needed before published cut-off values can be used with confidence in other populations.
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Affiliation(s)
- Barbara L Conner-Spady
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Eric Bohm
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Concordia Hip and Knee Institute, 310-1155 Concordia Avenue, Winnipeg, MB, R2K 2M9, Canada
| | - Michael J Dunbar
- Department of Orthopaedic Surgery, Dalhousie University, 1796 Summer Street, Suite 4822, Halifax, NS, B3H 4R2, Canada
| | - Lynda Loucks
- Concordia Hip and Knee Institute, 310-1155 Concordia Avenue, Winnipeg, MB, R2K 2M9, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Nakashima Y, Ishibashi S, Kitamura K, Yamate S, Motomura G, Hamai S, Ikemura S, Fujii M. 20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips. Bone Joint J 2022; 104-B:767-774. [PMID: 35775172 DOI: 10.1302/0301-620x.104b7.bjj-2021-1767.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). METHODS A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. RESULTS THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. CONCLUSION This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767-774.
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Affiliation(s)
- Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Yamate
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Orr MN, Klika AK, Emara AK, Piuzzi NS. Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty. J Arthroplasty 2022; 37:S110-S120.e5. [PMID: 35240283 DOI: 10.1016/j.arth.2022.02.090] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Value-driven healthcare models prioritize patient-perceived benefits to quantify the quality of care through patient-reported outcome measures (PROMs). The Patient Acceptable Symptom State (PASS) is the highest level of symptom beyond which a patient considers his/her condition satisfactory. We identified preoperative phenotypes of PROMs associated with not achieving PASS at 1 year following total knee arthroplasty (TKA) and explored the relationships between such phenotypes with hospital utilization parameters. METHODS A prospective institutional cohort of 5,274 primary TKAs for osteoarthritis from 2016 to 2019 with 1-year follow-up were included. Preoperative scores on Knee Disability and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-Physical function Short form (PS), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were used to develop patient phenotypes. Associations between preoperative "phenotype" and 1-year PASS, discharge disposition, length of stay, 90-day readmission, and 1-year reoperation were evaluated using multivariate regression. RESULTS In total, 16.3% (n = 862) of patients reported their state as "not acceptable" at 1 year. A combination of low scores in each of the presently examined PROMs was associated with the highest odds of 1-year dissatisfaction (odds ratio 2.18, 95% confidence interval 1.74-2.74). The PROM phenotypes were the greatest drivers compared to sociodemographic variables in predicting satisfaction. Combinations of low scores in VR-12 MCS and KOOS-PS were significantly associated with both non-home discharge status and prolonged length of stay. CONCLUSION Patients with combined lower preoperative scores across multiple PROMs (KOOS-Pain <41.7, KOOS-PS <51.5, and VR-12 MCS <52.8) have increased odds of dissatisfaction after TKA. Measuring pain, function, and mental health concurrently as phenotypes may help identify TKA patients at risk for not achieving a satisfactory outcome at 1 year.
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Affiliation(s)
- Melissa N Orr
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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