Variation in Demographics, Hospital, and Patient-Reported Outcomes Following Total Hip Arthroplasty According to Biological Sex

Mapping the importance of each individual element accounted by HOOS and VR-12 on 1-year patient satisfaction after primary total hip arthroplasty: a prospective institutional analysis

BACKGROUND

This study aimed to determine the significance of individual questions from the hip osteoarthritis outcome score (HOOS), HOOS Physical Function Shortform (PS), HOOS Joint Replacement (JR), and Veterans-Rand (VR)-12 mental composite score (MCS) in achieving a patient acceptable symptom state (PASS).

METHODS

A retrospective study of a prospectively collected cohort of 8236 unilateral elective primary THAs was analyzed. Responses were collected for 18 HOOS questions (pain, PS, and JR) and 6 VR-12 questions used to calculate MCS preoperatively and 1-year postoperatively. PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models stratified by sex.

RESULTS

Sex-specific differences in PASS attainment were observed. In males, a poorer preoperative response in HOOS-PS assessing a patient's difficulty to sit or run comfortably due to their hip was independently associated with reduced odds of achieving PASS at 1-year post-THA (odds ratio [OR] = 0.66 [95% confidence interval [CI] 0.52-0.83], P = 0.001, and OR = 0.83 [0.73-0.95], P = 0.01, respectively). Additionally, a more favorable preoperative response in the MCS metric of feeling down and blue (OR = 1.15 [95% CI 1.03-1.28], P = 0.01) was associated with increased PASS attainment, whereas a poorer preoperative response to having energy (OR = 0.86 [95% CI 0.76-0.97], P = 0.02) was associated with reduced PASS attainment. In females, only a poorer preoperative response in feeling calm and peaceful (OR = 0.87 [95% CI 0.78-0.96], P = 0.01) was associated with reduced odds of PASS attainment.

CONCLUSION

Individual questions of the HOOS and VR-12 MCS were identified as being independently associated with achieving patient satisfaction at one-year following THA. Notably, predictors of satisfaction differed by sex, with both physical function and mental health factors playing a larger role in males, while mental health alone was predictive in females. Understanding specific aspects that matter most to patients, such as mental health, allows healthcare providers to tailor their care to better meet patients' needs. This approach could involve counseling, stress management techniques, and interventions aimed at reducing feelings of depression and anxiety.

LEVEL OF EVIDENCE

III.

Measuring Short-Term Outcomes Following Primary Total Hip Arthroplasty: A Value-Based Healthcare Approach

Background/Objectives: Total hip arthroplasty (THA) is a highly effective treatment for end-stage hip disease, but the increasing volume of procedures demands a focus on value-based healthcare (VBHC) to ensure optimal outcomes. This study proposes a novel approach to evaluate the value delivered by THA using direct costs and patient-reported outcome measures (PROMs). Methods: This retrospective cohort study included patients undergoing primary THA for unilateral osteoarthritis at two hospitals between 2018 and 2021. PROMs specific to hip osteoarthritis were assessed preoperatively and in the second postoperative year. The delivered quality was calculated using PROM results in comparison with the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds. The associated cost was defined as direct THA expenses in comparison with the median direct costs of the cohort series, and the value was calculated as the ratio of quality over cost. A multivariable linear regression was performed to identify the factors associated with the THA value. Results: Among 224 patients (70 ± 10 years, 46% males), THA was of satisfactory value (≥1.0) for 82%. The THA value was lower for patients of female sex (β -0.27, p = 0.047), with higher preoperative PROMs (β -0.36, p < 0.001), previous contralateral THA (β -0.36, p = 0.049), or ipsilateral hip surgery (β -1.41, p < 0.001) with custom (β -0.76, p = 0.011) or fully cemented (β -0.83, p = 0.021) implants. Conclusions: The proposed methodology effectively assessed the THA value, revealing satisfactory outcomes for most patients but also identifying areas for improvement. These findings emphasize the need for risk-adjusted VBHC models to enhance equity and efficiency in arthroplasty care.