Hodson Noah M, McKegg Phillip C, Driessche Alexander, Raja Hamza M, North W Trevor, Charters Michael A
Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan.
J Arthroplasty. 2025 Apr 9. doi: 10.1016/j.arth.2025.04.019.
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly effective procedures, with the Centers for Medicare & Medicaid Services (CMS) mandating patient-reported outcome measures (PROMs) for Medicare patients starting July 1, 2024. This study evaluated PROM collection rates and identified predictors of substantial clinical benefit (SCB), defined by CMS as a 22-point improvement in Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement for THA and a 20-point improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement for TKA at four surgical sites across an academic tertiary referral center.
This retrospective cohort study analyzed PROM data for all patients who underwent THA or TKA from January 2021 to December 2022. Collection rates for PROMs were assessed by meeting the CMS requirement of "matched pairs" of preoperative and 1-year postoperative PROM and meeting SCB. Logistic regression was used to identify predictors of SCB.
Collection rates of PROMs improved from 2021 to 2022, but matched pair rates remained below 33%. The SCB was achieved by 70.9% of THA patients and 62.1% of TKA patients. Significant predictors of SCB included younger age, lower preoperative PROM scores, and absence of comorbidities such as diabetes or preoperative opioid use. Non-White race patients had significantly lower odds of achieving SCB for TKA (P = 0.003), while preoperative education did not significantly impact SCB rates for either procedure.
The collection of PROMs remains a major challenge, particularly for postoperative intervals, but patients who had greater initial limitations showed substantial improvement. Targeted interventions to optimize preoperative risk factors and enhance long-term follow-up may improve SCB rates and CMS compliance.
全髋关节置换术（THA）和全膝关节置换术（TKA）是非常有效的手术，医疗保险和医疗补助服务中心（CMS）规定自2024年7月1日起，医疗保险患者需报告患者报告结局指标（PROMs）。本研究评估了PROMs的收集率，并确定了显著临床获益（SCB）的预测因素，CMS将其定义为在一家学术三级转诊中心的四个手术部位，THA患者的髋关节功能障碍和骨关节炎关节置换结局评分提高22分，TKA患者的膝关节损伤和骨关节炎关节置换结局评分提高20分。
这项回顾性队列研究分析了2021年1月至2022年12月期间接受THA或TKA的所有患者的PROM数据。通过满足CMS对术前和术后1年PROM的“匹配对”要求以及达到SCB来评估PROMs的收集率。采用逻辑回归来确定SCB的预测因素。
2021年至2022年PROMs的收集率有所提高，但匹配对率仍低于33%。70.9%的THA患者和62.1%的TKA患者实现了SCB。SCB的显著预测因素包括年龄较小、术前PROM评分较低以及不存在糖尿病或术前使用阿片类药物等合并症。非白人种族患者实现TKA的SCB几率显著较低（P = 0.003），而术前教育对两种手术的SCB率均无显著影响。
PROMs的收集仍然是一项重大挑战，尤其是在术后间隔期，但初始限制较大的患者有显著改善。针对术前风险因素进行优化并加强长期随访的有针对性干预措施，可能会提高SCB率和CMS合规性。
