Klaassen Amanda D, Jorritsma Wiard, Willigenburg Nienke W, Gerritsma Carina L E, Ten Have Bas L E F, Moojen Dirk Jan F, Gademan Maaike G J, Groenwold Rolf H H, Poolman Rudolf W
Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam; Department of Orthopedics, Leiden University Medical Center, Leiden; Santeon Better Together Value-Based Health Care (VBHC) Program, Utrecht, the Netherlands.
Santeon Better Together Value-Based Health Care (VBHC) Program, Utrecht; Department of Quality and Improvement, OLVG Hospital, Amsterdam, the Netherlands.
Acta Orthop. 2025 Apr 14;96:310-316. doi: 10.2340/17453674.2025.43332.
This study introduces an innovative research design in the field of orthopedics, using a target trial emulation approach. We aimed to assess the causal effects of total hip arthroplasty (THA) compared with nonoperative treatment in reducing patient-reported hip disability at 3 months in patients with osteoarthritis, using real-world data.
We emulated a target trial using real-world data of 2 Dutch hospitals between April 2020 and January 2022. Patients diagnosed with hip osteoarthritis and eligible for primary THA were included in the study. During the COVID-19 pandemic, THA was often cancelled due to external factors (i.e., limited operating room capacity, or surgeon unavailable due to quarantine rules), resulting in an arbitrary allocation of patients to THA (n = 132) or non-THA (n = 60). We compared changes in hip disability, measured using the Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS), between the THA group at 3 months postoperatively and the non-THA group at ≥3 months post waiting-list. Linear regression analysis, adjusting for potential confounders, was used to compare between-group differences.
THA showed preferable outcomes compared with non-THA, indicated by a difference of -33 points (95% confidence interval [CI] -37 to -28) on the HOOS-PS. Patients in the THA group demonstrated a clinically significant improvement in hip function, with a mean change of -27 points (CI -31 to -24), while the control group showed no improvement with a mean change of 7 points (CI 3-11) on the HOOS-PS.
THA significantly improves hip function in osteoarthritis patients, surpassing the outcomes observed in the non-surgery group.
本研究在骨科领域引入了一种创新的研究设计，采用目标试验模拟方法。我们旨在利用真实世界数据，评估全髋关节置换术（THA）与非手术治疗相比，对骨关节炎患者术后3个月时患者报告的髋关节残疾程度的因果效应。
我们利用2家荷兰医院2020年4月至2022年1月的真实世界数据模拟了一项目标试验。纳入诊断为髋关节骨关节炎且符合初次THA条件的患者。在新冠疫情期间，THA常因外部因素（即手术室容量有限或外科医生因隔离规定无法出诊）而取消，导致患者被随机分配至THA组（n = 132）或非THA组（n = 60）。我们比较了THA组术后3个月和非THA组等待名单后≥3个月时使用髋关节残疾和骨关节炎结果评分身体功能简表（HOOS-PS）测量的髋关节残疾变化。采用线性回归分析并调整潜在混杂因素，以比较组间差异。
与非THA相比，THA显示出更好的结果，HOOS-PS上的差异为-33分（95%置信区间[CI] -37至-28）。THA组患者的髋关节功能有临床显著改善，平均变化为-27分（CI -31至-24），而对照组在HOOS-PS上平均变化为7分（CI 3-11），无改善。
THA显著改善骨关节炎患者的髋关节功能，超过非手术组观察到的结果。
