初次全髋关节置换术后髋关节障碍和骨关节炎结果评分中最小临床重要差异和患者可接受症状状态的诊断特异性阈值是什么？

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?

机构信息

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

出版信息

J Arthroplasty. 2024 Jul;39(7):1783-1788.e2. doi: 10.1016/j.arth.2024.01.051. Epub 2024 Feb 7.

DOI:10.1016/j.arth.2024.01.051

PMID:38331359

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.

摘要

背景

本研究旨在确定髋关节疾病和骨关节炎结果评分（HOOS）疼痛、物理短表（PS）和关节置换（JR）在初级全髋关节置换术后 1 年的最小临床重要差异（MCID）和患者可接受的症状状态（PASS）阈值，并根据术前诊断为骨关节炎（OA）与非 OA 进行分层。

方法

纳入了 2016 年 1 月至 2018 年 12 月期间接受初级全髋关节置换术的 5887 例患者的前瞻性机构队列。其中 4184 例患者（77.0%）完成了 1 年随访。记录了人口统计学、合并症以及基线和 1 年的 HOOS 疼痛、PS 和 JR 评分。患者根据术前诊断分为 OA 或非 OA。使用基于分布的方法估计最小可检测变化（MDC）和 MCID。使用基于锚定的方法估计 PASS 值，该方法对应于术后 1 年对满意度问题的反应。

结果

与 OA 患者相比，非 OA 队列的 MCID 阈值略高。（HOOS-疼痛：OA：8.35 分与非 OA：8.85 分；HOOS-PS：OA：9.47 分与非 OA：9.90 分；HOOS-JR：OA：7.76 分与非 OA：8.46 分）。同样，与 OA 患者相比，所有 MDC 阈值在非 OA 队列中均始终较高。与非 OA 队列相比，OA 队列在 HOOS-疼痛（OA：≥80.6 分与非 OA：≥77.5 分）、HOOS-PS（OA：≥83.6 分与非 OA：≥83.6 分）和 HOOS-JR（OA：≥76.8 分与非 OA：≥73.5 分）方面表现出相似或更高的 PASS 阈值。无论术前诊断如何，达到 MCID 和 PASS 阈值的患者百分比相似。