Hilibrand Ari S, Farid Alexander R, Desai Vineet, Lange Jeffrey K, Shah Vivek M, Chen Antonia F
From the Department of Orthopaedic Surgery (Hilibrand, Dr. Farid, Desai, Dr. Lange, Dr. Shah), Brigham and Women's Hospital, Boston, MA; the Harvard Medical School (Hilibrand, Dr. Farid, Desai, Dr. Lange, Dr. Shah), Boston, MA; and the Department of Orthopaedic Surgery (Dr. Chen), University of Texas Southwestern, Dallas, TX.
J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 29;9(8). doi: 10.5435/JAAOSGlobal-D-24-00385. eCollection 2025 Aug 1.
Osteoarthritis (OA) severity does not always correlate with clinical symptoms in joint arthroplasty candidates. Identifying metrics that correlate with clinical symptoms may inform strategies for OA treatment and optimization of arthroplasty timing. This study investigates the relationship between the novel metric of preoperative step count (SC) and radiographic OA severity compared with standard measures of preoperative pain/function.
A prospective cohort study was conducted on 611 preoperative primary hip and knee arthroplasty patients. A mobile application preoperatively collected daily SCs (30 days), pain levels (0 to 10), and PROMIS Global Physical (PROMIS-P) and Mental (PROMIS-M) scores. Total preoperative SCs were normalized, yielding steps/day-recorded. Reviewers assessed preoperative radiographs for Kellgren-Lawrence (KL) OA severity. Associations between OA severity, SCs, and patient-reported pain/function were assessed by ANCOVAs, t-tests, and linear regressions.
A total of 507 patients recorded steps. KL grade 4 (severe) patients took fewer steps/day-recorded than KL grade 1-3 patients (P = 0.01); among KL grade 1-3 patients, there were no significant differences (P = 0.16). No differences were observed in pain (P = 0.50) or PROMIS-P scores (P = 0.21) between KL grades. Steps were negatively correlated with BMI (P < 0.001) and age (P < 0.001). Men walked more than women (P < 0.0001). Preoperative steps were positively correlated with PROMIS-P scores (P < 0.001) and negatively correlated with pain (P = 0.003). Better mental health correlated with more steps (P = 0.009).
Preoperatively, KL grade 4 patients took fewer steps than KL grade 1-3 patients, yet their reported pain/function did not differ. This suggests that step counts provide additional information on joint degeneration unavailable from standard preoperative measures and may be useful in clinical decision making as a better clinical proxy for function than standard patient-reported metrics.
骨关节炎（OA）的严重程度在关节置换术候选者中并不总是与临床症状相关。确定与临床症状相关的指标可能为OA治疗策略及关节置换术时机的优化提供依据。本研究调查了术前步数（SC）这一新指标与放射学OA严重程度之间的关系，并与术前疼痛/功能的标准测量指标进行比较。
对611例术前初次髋关节和膝关节置换患者进行了一项前瞻性队列研究。术前通过移动应用程序收集每日步数（30天）、疼痛程度（0至10）以及患者报告的结果测量信息系统（PROMIS）身体功能（PROMIS-P）和精神健康（PROMIS-M）评分。术前总步数进行标准化处理，得出每日记录步数。阅片者评估术前X线片的Kellgren-Lawrence（KL）OA严重程度。通过协方差分析、t检验和线性回归评估OA严重程度、步数与患者报告的疼痛/功能之间的关联。
共有507例患者记录了步数。KL 4级（重度）患者的每日记录步数少于KL 1-3级患者（P = 0.01）；在KL 1-3级患者中，无显著差异（P = 0.16）。KL分级之间在疼痛（P = 0.50）或PROMIS-P评分（P =
