University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642.
J Arthroplasty. 2020 Oct;35(10):2899-2903. doi: 10.1016/j.arth.2020.05.006. Epub 2020 May 11.
The present study examines Patient Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) scores for domains of physical function (PF) and pain interference (PI) in patients undergoing elective THA from either a direct anterior or posterior surgical approach.
A total of 1358 patients who underwent THA at our institution from 1/1/2015 to 12/1/2018 were identified. Visual analog scale (VAS) pain scores, PROMIS CAT PF and PI data were collected at the last preoperative visit as well as 6 weeks, 6 months, and 1-2 years postoperatively. Literature-derived minimum clinically important difference (MCID) for PROMIS CAT PF metric with regard to THA was used for data comparison.
Four hundred nine patients were included in the final analysis. Fifty-one percent underwent a posterior approach, and 49% underwent a direct anterior approach. Both approaches led to a significant improvement in PROMIS CAT PF and PI scores. Patients undergoing a direct anterior approach had significantly higher preoperative and postoperative PROMIS CAT PF scores as well as significantly lower preoperative PROMIS CAT PI scores. Each approach yielded similar interval improvements of PROMIS CAT PF and PI. One hundred three direct anterior approach THA patients (51%) and 119 posterior approach THA patients (57.5%) achieved PROMIS PF MCID at 1- to 2-year follow-up.
Neither the direct anterior nor posterior THA surgical approach conferred an advantage to postoperative improvements of PROMIS CAT PF and PI scores. Adult reconstructive surgeons should continue to execute the direct anterior or posterior THA surgical approaches based upon personal preference. Despite surgeon confidence in THA, the potential for further innovation exists given the number of THA patients who failed to achieve PROMIS PF MCID.
本研究考察了接受直接前路或后路手术的择期全髋关节置换术（THA）患者的身体机能（PF）和疼痛干扰（PI）领域的患者报告结局测量信息系统（PROMIS）计算机自适应测试（CAT）评分。
本研究共纳入了 1358 例于 2015 年 1 月 1 日至 2018 年 12 月 1 日在我院接受 THA 的患者。术前最后一次就诊时以及术后 6 周、6 个月和 1-2 年时，收集了视觉模拟量表（VAS）疼痛评分、PROMIS CAT PF 和 PI 数据。采用文献报道的全髋关节置换术 PROMIS CAT PF 测量值的最小临床重要差异（MCID）进行数据比较。
最终有 409 例患者纳入了最终分析。51%的患者接受了后路手术，49%的患者接受了直接前路手术。两种手术方法均显著改善了 PROMIS CAT PF 和 PI 评分。直接前路手术患者的术前和术后 PROMIS CAT PF 评分明显更高，而术前 PROMIS CAT PI 评分明显更低。两种方法的 PROMIS CAT PF 和 PI 均取得了相似的阶段性改善。103 例直接前路 THA 患者（51%）和 119 例后路 THA 患者（57.5%）在 1-2 年随访时达到了 PROMIS PF MCID。
直接前路或后路 THA 手术方法均不能提高术后 PROMIS CAT PF 和 PI 评分的改善程度。成人重建外科医生应继续根据个人偏好选择直接前路或后路 THA 手术方法。尽管外科医生对 THA 充满信心，但鉴于有大量 THA 患者未达到 PROMIS PF MCID，仍存在进一步创新的潜力。
