Clement N D, Jones S, Qaddoura B, Afzal I, Kader D F
Southwest of London Orthopaedic Elective Centre, Epsom, UK.
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
Eur J Orthop Surg Traumatol. 2025 Jan 11;35(1):54. doi: 10.1007/s00590-024-04155-7.
The aim was to assess whether the postoperative Oxford Hip Score (OHS) demonstrated a ceiling effect at 1 or 2 years after total hip arthroplasty (THA) and to identify which patients are more likely to achieve a ceiling score and whether this limits assessment of their outcome.
A retrospective cohort of 7871 patients undergoing primary THA was identified from an established arthroplasty database. Patient demographics, ASA grade, socioeconomic status, OHS and EuroQol questionnaire were collected preoperatively and at 1 and 2 years postoperatively. Regression analysis was used to identify independent preoperative factors associated with achieving a ceiling score. Receiver operating characteristic curves were used to identify preoperative OHS's that predicted a postoperative ceiling score.
The ceiling effect (proportion achieving the maximal score) at 1 year was 21.8% (n = 1372) which increased significantly (p < 0.001) to 26.6% (n = 1569) at 2 years. Female gender (p ≤ 0.028), younger age (p < 0.001), decreasing socioeconomic deprivation (only for 2-year OHS), a better preoperative OHS (p < 0.001) or EQ-VAS (p < 0.001) were independently associated with a ceiling OHS postoperatively. The preoperative OHS was demonstrated to be a poor discriminator of achieving postoperative ceiling score at 1 year (AUC 62.4%, 95% CI 60.7 to 64.1, p < 0.001) and 2 years (AUC 61.5%, 95% CI 60.0 to 63.2). Those achieving a postoperative ceiling OHS at 1 and 2 years had statistically significant (p < 0.001) greater improvements in their OHS, EQ-5D and EQ-VAS and were more likely to have achieved a minimal important change in their OHS relative to their preoperative baseline and a postoperative patient acceptable symptom state.
The OHS demonstrated moderate ceiling effects at both 1 and 2 years following THA, and the preoperative score was a predictor of achieving a ceiling score. However, it would seem the ceiling effect did not limit the potential for improvements relative to baseline and achieving clinically meaningful values in the OHS.
目的是评估全髋关节置换术（THA）后1年或2年的牛津髋关节评分（OHS）是否显示出天花板效应，并确定哪些患者更有可能获得天花板分数，以及这是否限制了对其结果的评估。
从一个已建立的关节置换数据库中确定了7871例行初次THA的患者的回顾性队列。术前以及术后1年和2年收集患者的人口统计学资料、美国麻醉医师协会（ASA）分级、社会经济状况、OHS和欧洲五维健康量表问卷。采用回归分析确定与获得天花板分数相关的独立术前因素。使用受试者工作特征曲线来确定预测术后天花板分数的术前OHS。
1年时的天花板效应（达到最高分的比例）为21.8%（n = 1372），2年时显著增加（p < 0.001）至26.6%（n = 1569）。女性（p≤0.028）、年龄较小（p < 0.001）、社会经济剥夺程度降低（仅适用于2年OHS）、术前OHS较好（p < 0.001）或欧洲五维健康量表视觉模拟量表（EQ-VAS）较好（p < 0.001）与术后OHS达到天花板效应独立相关。术前OHS在1年（曲线下面积[AUC] 62.4%，95%可信区间[CI] 60.7至64.1，p < 0.001）和2年（AUC 61.5%，95% CI 60.0至63.2）时对预测术后天花板分数的辨别能力较差。在1年和2年达到术后OHS天花板效应的患者，其OHS、EQ-5D和EQ-VAS有统计学显著改善（p < 0.001），并且相对于术前基线，其OHS更有可能实现最小重要变化以及达到术后患者可接受的症状状态。
THA后1年和2年OHS均显示出中度天花板效应，术前分数是获得天花板分数的一个预测指标。然而，天花板效应似乎并未限制相对于基线的改善潜力以及在OHS中获得临床有意义的值。
