Elmallah Randa K, Chughtai Morad, Adib Farshad, Bozic Kevin J, Kurtz Steven M, Mont Michael A
1Department of Orthopaedic Surgery, University of Mississippi, Jackson, Mississippi 2Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio 3Department of Orthopaedics, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland 4Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas 5Drexel University, Philadelphia, Pennsylvania.
J Bone Joint Surg Am. 2017 Mar 15;99(6):494-498. doi: 10.2106/JBJS.15.01351.
Following total hip arthroplasty, patients' perception of their postoperative improvement and health plays a large role in satisfaction with and success of the surgical procedure. The Short Form-6D (SF-6D) is a health-related quality-of-life measure that assigns numerical value to the perception of patients' own health. The purpose was to determine SF-6D values of patients after total hip arthroplasty, to determine whether score changes were clinically relevant, and to compare these with postoperative functional improvements.
We evaluated 188 patients who underwent primary total hip arthroplasty at 7 institutions and who had a mean age of 69 years (range, 47 to 88 years) and a mean body mass index of 28.8 kg/m (range, 19.8 to 38.9 kg/m). The SF-6D values were obtained from patients' SF-36 scores, and clinical relevance of value changes was determined using effect size. Using previous research, effect sizes were considered small between 0.2 and 0.5, moderate between 0.6 to 0.8, and large at >0.8. Clinical correlation was assessed using the Lower-Extremity Activity Scale and Harris hip scores. Patients were assessed preoperatively and postoperatively at 6 months and 1, 2, 3, and 5 years.
The SF-6D scores improved from preoperatively and achieved significance (p < 0.05) at all points. The effect size demonstrated good clinical relevance up to the latest follow-up: 1.27 at 6 months, 1.30 at 1 year, 1.07 at 2 years, 1.08 at 3 years, and 1.05 at 5 years. The Lower-Extremity Activity Scale improved at all follow-up points from preoperatively to 1.8 at 6 months, 2.0 at 1 year, 1.8 at 2 years, 1.5 at 3 years, and 1.6 points at 5 years. The Harris hip score improved to 38 points at 6 months, 40 points at 1 year, 38 points at 2 years, 39 points at 3 years, and 41 points at 5 years postoperatively. The improvements in the Lower-Extremity Activity Scale and the Harris hip score significantly positively correlated (p < 0.01) with the SF-6D scores at all time points.
SF-6D scores after total hip arthroplasty correlate with functional outcomes and have clinical relevance, as demonstrated by their effect size. Incorporating this straightforward and easy-to-use measurement tool when evaluating patients following total hip arthroplasty will facilitate future cost-utility analyses.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术后，患者对术后改善情况和健康状况的认知在对手术的满意度及手术成功与否方面起着重要作用。简式36健康调查简表6维度健康状况量表（SF - 6D）是一种与健康相关的生活质量测量工具，它能为患者对自身健康的认知赋予数值。本研究的目的是确定全髋关节置换术后患者的SF - 6D值，判断得分变化是否具有临床相关性，并将其与术后功能改善情况进行比较。
我们评估了在7家机构接受初次全髋关节置换术的188例患者，这些患者的平均年龄为69岁（范围47至88岁），平均体重指数为28.8 kg/m²（范围19.8至38.9 kg/m²）。从患者的SF - 36评分中获取SF - 6D值，并使用效应量来确定数值变化的临床相关性。根据先前的研究，效应量在0.2至0.5之间被认为是小效应，在0.6至0.8之间为中等效应，大于0.8为大效应。使用下肢活动量表和Harris髋关节评分评估临床相关性。患者在术前以及术后6个月、1年、2年、3年和5年进行评估。
SF - 6D评分从术前开始改善，在所有时间点均具有统计学意义（p < 0.05）。直至最新随访，效应量显示出良好的临床相关性：6个月时为1.27，1年时为1.30，2年时为1.07，3年时为1.08，5年时为1.05。下肢活动量表从术前到各随访时间点均有改善，6个月时为1.8，1年时为2.0，2年时为1.8，3年时为1.5，5年时为1.6分。Harris髋关节评分术后6个月提高到38分，1年时为40分，2年时为38分，3年时为39分，5年时为41分。下肢活动量表和Harris髋关节评分的改善在所有时间点均与SF - 6D评分显著正相关（p < 0.01）。
全髋关节置换术后的SF - 6D评分与功能结果相关且具有临床相关性，其效应量证明了这一点。在评估全髋关节置换术后的患者时纳入这种简单易用的测量工具将有助于未来的成本效用分析。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
