Pasqualini Ignacio, Benyamini Brian, Khan Shujaa T, Zielinski Matthew, Piuzzi Nicolas S
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
J Arthroplasty. 2025 May 6. doi: 10.1016/j.arth.2025.04.065.
Patient-reported outcome measures (PROMs) are increasingly important in assessing revision total hip arthroplasty (THA) outcomes, yet diagnosis-specific thresholds for clinical relevance remain largely undefined. This study aimed to determine diagnosis-specific minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) thresholds for the Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales in aseptic revision THA.
A prospective cohort of 466 patients who underwent aseptic revision THA between 2016 and 2022 was analyzed. Patients were stratified by diagnosis: aseptic loosening (n = 232), implant failure (n = 112), instability (n = 78), and periprosthetic fracture (n = 44). The HOOS-pain, HOOS-physical function short form (PS), and HOOS-Joint Replacement (JR) scores were collected preoperatively and at a 1-year follow-up. The MCID was calculated using distribution-based methods, while PASS and SCB were determined using anchor-based approaches.
The MCID thresholds ranged from 10.0 (aseptic loosening) to 12.9 (periprosthetic fracture) for HOOS-pain, 9.9 (instability) to 12.9 (periprosthetic fracture) for HOOS-PS, and 8.7 (aseptic loosening) to 12.1 (periprosthetic fracture) for HOOS-JR. The PASS thresholds varied from 67.5 (implant failure) to 72.5 (periprosthetic fracture) for HOOS-pain, 76.6 (periprosthetic fracture) to 80.0 (aseptic loosening, implant failure, and instability) for HOOS-PS, and 64.7 (aseptic loosening) to 73.5 (implant failure and instability) for HOOS-JR. The SCB thresholds spanned 15 (implant failure) to 35 (aseptic loosening) for HOOS-pain, 4.6 (periprosthetic fracture) to 22.0 (instability) for HOOS-PS, and 16.1 (instability) to 25.9 (implant failure) for HOOS-JR.
This study established diagnosis-specific thresholds for MCID, PASS, and SCB across HOOS subscales in aseptic revision THA, demonstrating significant variability by preoperative diagnosis. Patients who have aseptic loosening showed the greatest improvement and highest likelihood of achieving clinically meaningful benefits, while those who have periprosthetic fractures and instability had lower rates of meaningful recovery. These findings provide a critical framework for outcome assessment and personalized patient counseling.
患者报告结局测量（PROMs）在评估翻修全髋关节置换术（THA）结局方面日益重要，但临床相关性的诊断特异性阈值在很大程度上仍未明确。本研究旨在确定无菌性翻修THA中髋关节残疾和骨关节炎结局评分（HOOS）子量表的诊断特异性最小临床重要差异（MCID）、患者可接受症状状态（PASS）和实质性临床获益（SCB）阈值。
分析了2016年至2022年间接受无菌性翻修THA的466例患者的前瞻性队列。患者按诊断分层：无菌性松动（n = 232）、植入物失败（n = 112）、不稳定（n = 78）和假体周围骨折（n = 44）。术前及1年随访时收集HOOS疼痛、HOOS身体功能简表（PS）和HOOS关节置换（JR）评分。MCID采用基于分布的方法计算，而PASS和SCB采用基于锚定的方法确定。
HOOS疼痛的MCID阈值范围为10.0（无菌性松动）至12.9（假体周围骨折），HOOS-PS为9.9（不稳定）至12.9（假体周围骨折），HOOS-JR为8.7（无菌性松动）至12.1（假体周围骨折）。HOOS疼痛的PASS阈值从67.5（植入物失败）到72.5（假体周围骨折）不等，HOOS-PS从76.6（假体周围骨折）到80.0（无菌性松动、植入物失败和不稳定）不等，HOOS-JR从64.7（无菌性松动）到73.5（植入物失败和不稳定）不等。HOOS疼痛的SCB阈值范围为15（植入物失败）至35（无菌性松动），HOOS-PS为4.6（假体周围骨折）至22.0（不稳定），HOOS-JR为16.1（不稳定）至25.9（植入物失败）。
本研究确定了无菌性翻修THA中HOOS各子量表的MCID、PASS和SCB的诊断特异性阈值，表明术前诊断存在显著差异。无菌性松动的患者改善最大，获得临床有意义获益的可能性最高，而假体周围骨折和不稳定的患者有意义恢复的比例较低。这些发现为结局评估和个性化患者咨询提供了关键框架。
