Geilen Julia E J W, Hoelen Thomay-Claire A, Schotanus Martijn G M, van Hemert Wouter L W, Spekenbrink-Spooren Anneke, Boonen Bert, Most Jasper
Department Orthopedics and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
Department Orthopedic Surgery, CAPHRI, Maastricht University Medical Center+, Maastricht, The Netherlands.
Arthroplast Today. 2025 Mar 3;32:101649. doi: 10.1016/j.artd.2025.101649. eCollection 2025 Apr.
Clinically meaningful thresholds for patient-reported outcomes are relevant to define and predict success of total hip arthroplasties (THAs). Defining and offering thresholds must consider preoperative symptom severity.
In this retrospective study of 40,213 primary total hip replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes and patient-acceptable symptom states with the anchor transition in function. Subgroups were identified for which independent thresholds should be defined. Patient-reported outcome measures were symptoms (pain, Oxford Hip Score [OHS], Hip disability and Osteoarthritis Outcome Score) and quality of life (European Quality of Life 5 Dimensions 3L questionnaire).
94.6% completed the anchor questions, of whom 80.1% reporting "much improved function" 1 year after surgery. Discriminative abilities of thresholds were not good (area under the curve < 0.8). Tercile-specific determination of thresholds improved discrimination and reliability (+10%). Minimal clinically important change values were higher for all outcomes (eg, change in OHS ≥ 24.5 vs ≥ 10.5) in patients with more severe preoperative symptoms. Patient-acceptable symptom state scores for European Quality of Life 5 Dimensions index (≥ 0.809) and OHS (≥ 40.5) showed good discrimination (area under the curve > 0.8). Patients with less symptoms required lower postoperative scores for reporting "much improved function" (postoperative OHS ≥ 38.5 vs 42.5). Tercile-specific thresholds did not improve accuracy of thresholds (Cohens kappa 42%).
The present study demonstrates that patients with more severe preoperative symptoms require greater change scores to achieve clinically relevant improvements than patients with less severe preoperative symptoms. This study suggests that current one-size-fits-all thresholds for success of THA should be replaced with more nuanced thresholds.
Level III, Therapeutic Study.
患者报告结局的具有临床意义的阈值对于定义和预测全髋关节置换术（THA）的成功至关重要。定义和提供阈值时必须考虑术前症状的严重程度。
在这项对荷兰关节置换登记处登记的40213例初次全髋关节置换术（2016 - 2018年）的回顾性研究中，采用接受者操作曲线分析来定义最小临床重要变化和具有功能锚定转换的患者可接受症状状态。确定了应定义独立阈值的亚组。患者报告的结局指标包括症状（疼痛、牛津髋关节评分[OHS]、髋关节残疾和骨关节炎结局评分）和生活质量（欧洲生活质量5维度3水平问卷）。
94.6%的患者完成了锚定问题，其中80.1%的患者报告术后1年“功能有很大改善”。阈值的判别能力不佳（曲线下面积<0.8）。按三分位数确定阈值可提高判别力和可靠性（提高10%）。术前症状较严重的患者，所有结局的最小临床重要变化值更高（例如，OHS变化≥24.5对比≥10.5）。欧洲生活质量5维度指数（≥0.809）和OHS（≥40.5）的患者可接受症状状态评分显示出良好的判别力（曲线下面积>0.8）。症状较轻的患者报告“功能有很大改善”所需的术后评分较低（术后OHS≥38.5对比42.5）。按三分位数确定的阈值并未提高阈值的准确性（科恩kappa系数42%）。
本研究表明，术前症状较严重的患者与术前症状较轻的患者相比，需要更大的变化分数才能实现临床相关改善。本研究表明，当前THA成功的一刀切阈值应被更细致入微的阈值所取代。
III级，治疗性研究。
