Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY.
J Bone Joint Surg Am. 2022 Feb 16;104(4):345-352. doi: 10.2106/JBJS.21.00550.
It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA.
A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ≥70 years of age), sex (men or women), body mass index (BMI; <30 or ≥30 kg/m2), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ≥50).
The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores (≥50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ≥70 years of age, but was equivalent for the KOOS JR.
The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively. The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
为了了解医疗质量，对全关节置换术后（TJA）可接受的结果进行量化是至关重要的。本研究的目的是为膝关节损伤和骨关节炎评分（KOOS JR）和髋关节残疾和骨关节炎评分（HOOS JR）定义 TJA 后患者可接受的症状状态（PASS）阈值。
使用接受者操作特征（ROC）曲线分析，以 2 年的“中度改善”或更好的满意度作为锚点，对 2007 年至 2012 年期间使用机构登记处接受初次全髋关节置换术的 5216 例患者和初次全膝关节置换术的 4036 例患者进行分析，以确定 PASS 阈值。通过分层和重新计算手术时年龄（<70 岁或≥70 岁）、性别（男性或女性）、体重指数（BMI；<30 或≥30kg/m2）和基线简短表格-36（SF-36）身体和心理成分评分（<50 或≥50）的这些阈值，探讨了 PASS 阈值的变化。
HOOS JR 的 PASS 阈值为 76.7（ROC 曲线下面积[AUC]为 0.91），有 4334 例患者（83.1%）达到了这一阈值。KOOS JR 的 PASS 阈值为 63.7（AUC = 0.89），有 3461 例患者（85.8%）达到了这一阈值。协变量分层表明，与女性相比，男性的 PASS 阈值更高，与较低的 SF-36 身体和心理评分（<50）相比，较高的 SF-36 身体和心理评分（≥50）的 PASS 阈值更高。在 BMI 和年龄方面，仪器之间的结果有所不同：较高的 BMI 与 HOOS JR 的 PASS 阈值较低有关，但与 KOOS JR 的 PASS 阈值较高有关。与≥70 岁的患者相比，<70 岁的患者的 HOOS JR PASS 阈值更高，但 KOOS JR 的 PASS 阈值则相当。
TJA 后 2 年 HOOS JR 和 KOOS JR 的 PASS 阈值分别为 76.7 和 63.7。PASS 阈值与某些术前因素有关，这表明 TJA 后可接受的症状状态受患者特定因素的影响。
预后 IV 级。有关证据水平的完整描述，请参见作者说明。
