全髋关节置换术后病人健康相关生存质量评估

[目的]评价Harris评分在全髋关节置换术疗效评估中的局限性。[方法]对2005年9月~2006年1月47例(50髋)接受全髋关节置换术的病人进行6个月的前瞻性研究。在术前和术后6个月均对病人进行Harris评分和评估健康相关生存质量的SF-36简明健康状况调查量表(MOS36-item Short Form Health Survey,SF-36)评分,并分析Harris评分和SF-36各项评分之间的相关性。[结果]病人术后6个月的Harris评分和SF-36各项评分均较术前有统计学意义上的差异(P<0.001),但SF-36各项评分的改善程度并不一致。Harris评分和SF-36生理功能(PF)和躯体疼痛(BP)项评分有相关性(r>0.4,P<0.001),但与SF-36其它方面评分无明显相关性(r<0.4),或无相关性(P>0.05)。[结论]虽然Harris评分能较好地评估全髋关节置换术对改善病人生理功能和缓解疼痛的疗效,但对于评价病人健康相关生存质量和其它方面的改善还存在局限性。因此,有必要将SF-36评分引入到全髋关节置换术的疗效评估中。     

全髋关节置换术后患者进行网络媒介支持的远程康复效果评价

目的探讨全髋关节置换术后患者进行网络媒介支持的远程康复对髋关节功能及生存质量的影响。方法纳入自2020-01—2021-01完成的36例全髋关节置换术,18例出院后进行网络媒介支持的远程康复(观察组),18例进行传统电话随访进行康复指导(对照组)。比较两组出院10周后髋关节功能Harris评分及SF-36量表总分。结果 36例出院后康复训练依从性良好,康复训练期间未出现明显并发症,完成10周康复训练后进行效果评价。观察组出院10周后髋关节功能Harris评分为(75.00±5.17)分,高于对照组的(67.61±6.30)分,差异有统计学意义(P0.05)。观察组出院10周后SF-36量表总分为(79.39±3.93)分,高于对照组的(75.83±5.91)分,差异有统计学意义(P0.05)。结论网络媒介支持的远程康复模式较常规电话随访和门诊复诊更能促进全髋关节置换术后患者髋关节功能恢复及生活质量提高。     

术前功能对初次人工全髋关节置换术后早期功能的影响

[目的]探讨术前功能状态对初次全髋关节置换术(THA)术后早期功能的影响.[方法]对2006年1月-2008年1月期间在本科行初次非骨水泥型全髋关节置换的髋关节骨性关节炎95例患者进行随访研究,其中男49例,女46例,平均年龄62.7岁(50～76周岁),随访时间大于24个月.根据患者术前Harris评分(HHS)将患...     

SF-36量表应用于人工髋关节置换患者生命质量测定的效果评价

[目的]探讨SF-36量表用于测定人工髋关节置换手术患者生命质量的可能性。[方法]用SF-36量表测定90例人工髋关节置换手术患者，对结果进行信度、效度和反应度分析。[结果]通过因子分析发现，SF-36量表具有较好的结构效度。8个维度的重测信度较好均大于0．7，其中情感角色限制（RE）纬度最低为0．71。其内部一致性系数分别为，生理功能0．79、躯体疼痛0．77、健康总体自评0．80、社会功能0．74、心理健康0．88，除生理角色限制0．43，活力0．57及情感角色限制0．15外其余均大于0．7。髋关节置换病人在术前与术后的反应度比较上SF-36量表各纬度得分术后均高于术前（P〈0．01），说明量表的敏感性较高。[结论]SF-36用于测量中国人工髋关节置换手术患者的生命质量，具有较好的信度、效度和反应度。     

生物型髋关节假体位置参数与患者生命质量相关性研究

目的分析初次生物型全髋关节置换术(THA)后假体位置重建情况,探讨假体位置参数与患者生命质量的相关性,总结假体位相参数的安全范围。 方法对南京市六合区人民医院骨科2013年3月至2015年3月52例因股骨颈骨折行初次生物型全髋关节置换术的患者进行2年的前瞻性研究。术后第3天未负重前首次拍摄患侧髋关节正侧位及骨盆正位X线片,分析髋臼及股骨柄假体的位置参数,包括髋臼外展角、髋臼前倾角、股骨头旋转中心、股骨垂直偏距、股骨偏心距、外展肌力臂、重力力臂、股骨柄内外翻、颈干角。术前和术后24个月对患者进行评估健康相关生命质量的SF-36简明健康状况调查量表(SF-36)评分。采用SPSS 17.0软件对量表进行Cronbach's (系数同质性分析、Pearson相关分析、因子分析及t检验以评价其信效度,并评价假体位置参数与SF-36各项评分提高值之间的相关性。 结果52名患者(52髋)均完成了随访,根据THA术后首次X线片获取假体位置参数。除情感职能外,手术前后的SF-36量表内部一致性显示Cronbach's α系数>0.7;重测信度显示相关系数(CC)ICC>0.8;分半信度显示Pearson相关系数>0.874;反应度显示SF-36量表能较好地反应THA患者手术前后的生命质量变化状况;结构效应单因子分析结果示全部36个条目在各自维度上的因子载荷为0.23～0.87(P<0.05),其中3个条目的载荷小于0.30。多因子分析结果χ²/df＝3.16,拟合优度指数(GFI)＝0.892,近似误差均方根(RMSEA)＝0.089,表明SF-36的各拟舍指数均在可被接受水平;证明SF-36的内部结构与其理论架构有很高的一致性。假体位置参数与SF-36各维度的相关系数都为正数,除GH外SF-36各维度与髋臼假体位相参数间相关系数均大于0.6,SF-36各维度与髋关节旋转中心体位相参数间高度相关,SF-36中活力(VT)、社会功能(SF)、情感职能(RE)及精神健康(MH)与股骨垂直偏距间相关系数大于0.7,SF-36中各维度与两侧股骨偏心距比例参数间相关系数均大于0.7,SF-36中SF、MH与外展肌力臂及重力力臂相参数间相关系数大于0.8,余者均大于0.7,SF-36各维度与股骨柄假体位相参数间相关系数在0.329～0.757之间,SF-36中生理功能(PF)、生理职能(RP)、社会功能(SF)与颈干角位相参数间相关系数在大于0.7。 结论SF-36量表信度、效度均较好,可用以评估THA患者生命质量。股骨颈骨折患者的生命质量在各个领域均明显低于正常人,THA术后均得到改善。SF-36各维度可全面反映患者心理、生理及社会生活状态下的生命质量。通过对假体位相参数与SF-36各维度间的相关系数分析认为：髋臼外展角及前倾角的适当范围分别为(45±5)°、(15±5)°;颈干角应控制在(125±10)°内;髋臼假体应置于髋臼解剖位置上,以健侧为参照重建旋转中心;术后患侧肢体长度较健侧缩短不宜超过10 mm;避免减小股骨偏心距、外展肌及重力力臂;尽量保持股骨柄中立位。     

人工髋关节置换术后患者生存质量的调查

目的：分析人工髋关节置换术术后深静脉血栓对患者的影响及护理方法,提高人工髋关节置换术后患者的生存质量。方法：采用以护理干预方式给予人工髋关节置换术患者进行护理干预,并在出院3个月、6个月时用哈里斯髋关节计分法（HHS）和36项短型健康调查（SF-36）进行评估。结果：70例患者作业完成或基本完成（得分74～100分）,HHS评分和SF-36评分各项明显高于术前,差异有统计学意义（P〈0．05）。结论：护理干预有助于人工髋关节置换术患者的康复,使患者生存质量提高。     

早泄诊断量表的汉化研究和信效度评价

目的:对英文版早泄诊断量表(PEDT)进行汉化,并评价PEDT量表的信度和效度,分析其在早泄诊断的可行性。方法:首先对PEDT量表进行翻译、回译和审议修订,在全国15家泌尿外科或者男科门诊选取早泄患者填写受试者的一般情况、PEDT量表和阴道内射精潜伏时间(IELT),并以性功能正常男性填写此量表作为对照。采用Cronbach's alpha检验PEDT量表内部一致性,采用test-retest检验评价PEDT量表的重测信度和稳定性,并分析PEDT量表与IELT的相关性以及PEDT量表的敏感性和特异性。结果:本研究共有570例早泄患者[年龄(30.66±7.11)岁]和226例正常男性[年龄(33.01±5.41)岁]参与,其中早泄组和正常组的IELT分别为(1.34±0.54)min和(11.09±7.5)min。PEDT量表的Cronbach's alpha系数为0.79,重测信度为0.75(P0.01);PEDT量表评分与IELT之间存在显著的负相关性(Spearman'sρ=-0.52,P0.01);当诊断早泄的切点值为7.5时,PEDT量表的敏感性和特异性分别为0.80和0.78;当诊断早泄的切点为8.5时,PEDT量表的敏感性和特异性分别为0.72和0.89。结论:PEDT量表中文汉化版具有良好的内部一致性、信度和效度,对我国早泄患者有良好的预测能力,为早泄的临床评估应用提供了一个可靠、简便的测量工具。     

肥胖对初次人工全髋关节置换术临床疗效影响的Meta分析

[目的]用Meta分析的方法探讨肥胖对初次人工全髋关节置换术(total hip arthroplasty,THA)临床疗效的影响。[方法]计算机检索数据库Pub Med、EBSCO、The Cochrane Library、Wan Fang、CNKI中关于肥胖对全髋关节置换术临床疗效的文献,检索时限为2016年8月1日之前。按纳入、排除标准进行前瞻性病例对照研究筛查,采用Newcastle Ottawa Scale(NOS)文献质量评价量表对文献进行质量评估,采用Rev Man 5.2软件进行Meta分析。[结果]纳入18篇文献,10 047例患者,肥胖组2 985例,非肥胖组7 062例。Meta分析结果显示:与非肥胖组相比,肥胖组可以显著增加THA手术时间(WMD=10.82,95%CI[4.83,16.82],P=0.000 4)、术后脱位率(RR=2.08,95%CI[1.55,2.79],P<0.000 01)、感染率(RR=3.68,95%CI[2.18,6.22],P<0.000 01)、失血量(WMD=169.14,95%CI[73.24,265.05],P=0.000 5),显著降低Harris Hip Score(HHS)评分(WMD=-3.40,95%CI[-5.41,-1.40],P=0.000 9);但两组住院时间(WMD=-0.19,95%CI[-0.38,-0.00],P=0.05)差异无统计学意义。[结论]肥胖增加人工全髋关节置换手术时间、失血量及术后脱位、感染并发症发生率,影响患者术后髋关节功能恢复。肥胖对初次人工全髋关节置换术临床疗效产生负面影响。     

移动平台型假体与固定平台型假体全膝置换术治疗膝关节炎疗效的Meta分析

目的 用Meta分析方法对移动平台型全膝关节置换术(mobile-bearing TKA)与固定平台型全膝置换术(fixed-bearing TKA)术后疗效进行系统评价的文献近期未见有发表,本文即用Meta分析方法对使用两种假体全膝关节置换术术后两年以上的疗效进行评价。方法 检索关于移动平台型全膝关节置换术和固定平台型全膝关节置换术病例对照的相关文献,按照特定的纳入和排除标准选择文献并提取数据,用Review Manager5.0软件对数据进行meta分析。结果 最终共纳入12篇随机对照研究(Jadad评分均在3~5分之间)。数据分析结果显示,应用两组假体的临床疗效在KSS-膝关节评分[MD=0.76,95%CI(-0.07,1.69),P=0.07]、SF-12生命质量生理评分[MD=-0.16,95%CI(-2.15,1.83),P=0.88]和SF-12生命质量心理评分[MD=0.64,95%CI(-1.28,2.57),P=0.51]方面的差别无统计学意义,而在KSS-膝功能评分[MD=3.26,95%CI(1.39,5.13),P=0.0006]和关节活动度[MD=2.68,95%CI(1.73,3.61),P<0.00001]方面的差别有统计学意义。结论 本Meta分析发现,使用移动平台型假体全膝置换术后,能在一定程度上提高患者的KSS-膝功能评分和关节活动度,但并不能提高患者KSS-膝关节评分、SF-12生命质量生理和心理方面评分。     

全膝关节置换术患者居家康复训练依从性量表的编制及信效度检验

目的构建全膝关节置换术患者居家康复训练依从性评估工具。方法参考相关文献联合讨论法形成初始全膝关节置换术患者居家康复训练依从性量表(依从性量表),进行2轮专家咨询,发放给176例全膝关节置换术患者检验其信效度。结果专家积极性为84.62%、81.82%,专家协调系数为0.332,专家权威系数为0.839;依从性量表含3个维度11个条目,累积方差贡献率为69.855%;I-CVI为0.889～1.000,S-CVI为0.978,3个维度及量表总的Cronbach′sα系数为0.747～0.885及0.850,各维度与总分的相关系数r为0.622～0.865。结论全膝关节置换术患者居家康复训练依从性量表编制合理,信度效度较好,可作为全膝关节置换术患者居家康复训练依从性评估工具。     

The short form-12 and the measurement of health status in patients with cerebral aneurysms: performance, validity, and reliability

OBJECT: Cerebral aneurysms can affect a patient's health status by rupture and stroke, impingement on neural structures, treatment side effects, or psychological stress. The authors assessed the performance, validity, and reliability of the Short Form-12 (SF-12), a self-administered written survey instrument, to assess health status in patients with cerebral aneurysms. METHODS: A cohort of 170 patients with cerebral aneurysms who were seen at a neurosurgery clinic underwent structured interviews including measurement of their health statuses (SF-12 physical component summary [PCS] and mental component summary [MCS]), functional status (Glasgow Outcome Scale score, modified Rankin Scale score, and Barthel Index), and mental health (Hospital Anxiety and Depression Scale score). The SF-12 scores were compared with US population norms by performing t-tests with unequal variances. The validity of the SF-12 was assessed by comparing the PCS and MCS scores with each patient's functional status and mental health scores by using rank-order methods. Inter-item reliability was assessed using the Cronbach alpha statistic. Patients with cerebral aneurysms had decreased health status PCS and MCS scores when compared with population norms (p < 0.001 for all). A history of subarachnoid hemorrhage (SAH) (p = 0.006) and previous surgical or endovascular treatment (p = 0.047) was associated with worse PCS scores. The validity of the SF-12 was supported by the relationship between the PCS and MCS scores and the patient's functional status and mental health (p < 0.001 for all). The reliability of the SF-12 was documented by the Cronbach alpha statistic (alpha = 0.76). CONCLUSIONS: Patients with cerebral aneurysms have a diminished physical and mental health status as measured using the SF-12. The presence of SAH and aneurysm treatment are associated with a worse physical health status. The SF-12 is a valid and reliable instrument for measuring health status in patients with cerebral aneurysms.     

Should aggregate scores of the Medical Outcomes Study 36-item Short Form Health Survey be used to assess quality of life in knee and hip osteoarthritis? A national survey in primary care

OBJECTIVE: To assess the relevance of using the aggregate physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) for patients with knee and hip osteoarthritis (OA). METHODS: We conducted a cross-sectional national survey in a primary care setting in France. A total of 1474 general practitioners enrolled 4183 patients with hip or knee OA. Construct validity of PCS and MCS was assessed by convergent and divergent validity and factor analysis. RESULTS: Records of 4133 patients (98.8%) were analyzed (2540 knee, 1593 hip OA). PCS mean scores were 32.0+/-8.4 and 31.8+/-8.4 and MCS scores 47.1+/-11.0 and 46.8+/-11.1, for knee and hip OA, respectively. Acceptable convergent and divergent validity was observed, and correlation between PCS and MCS mean scores was low (r=0.14). However, factor analysis performed on the eight subscale scores failed to support the use of PCS and MCS aggregate scores. It extracted two factors which were similar for both OA types and differed from the a priori stratification. Scores for two subscales usually attributed to MCS - emotional role and social functioning - were shared between factors, and scores for another subscale - general health perception - usually belonging to the PCS was in the mental component factor. CONCLUSIONS: Our results suggest that aggregate scores from the PCS and MCS of the SF-36 as they are currently defined may not be optimal for used in hip and knee OA patients to assess health-related quality of life.     

慢性自身免疫性疾病患者初次人工全髋关节置换术后中远期疗效

目的探讨慢性自身免疫性疾病患者行初次人工全髋关节置换(total hip arthroplasty,THA)术后的中远期疗效。方法 1990年1月-2006年6月,对42例(51髋)慢性自身免疫性疾病患者行初次THA。男15例(18髋),女27例(33髋);年龄22～70岁,平均36.9岁。左侧29髋,右侧22髋。其中系统性红斑狼疮11例(13髋),类风湿性关节炎16例(22髋),强直性脊柱炎15例(16髋)。髋关节置换原因:股骨头缺血性坏死26例(34髋),髋关节僵硬15例(16髋),股骨颈骨折1例(1髋)。术前髋关节Harris评分为(32.49±9.50)分;简明健康调查量表(SF-36量表)中体能方面总分(physical component summary,PCS)为(25.53±4.46)分,精神方面总分(mental component summary,MCS)为(42.28±6.27)分。结果术后患者切口均Ⅰ期愈合。42例患者均获随访,随访时间5～21年,平均9.1年。末次随访时Harris评分为(89.25±8.47)分;SF-36量表评分PCS为(51.35±4.28)分,MCS为(55.29±8.31)分;与术前比较差异均有统计学意义(P<0.05)。术后并发症包括跛行(4例)、假体脱位(2例2髋)、假体周围骨折(1例1髋)、假体无菌性松动(2例2髋)以及异位骨化(3例3髋)。结论对于慢性自身免疫性疾病引起的髋关节功能丧失,采用THA治疗可获得较好疗效。     

Assessment of health-related quality of life after surgical treatment of focal symptomatic spinal stenosis compared with osteoarthritis of the hip or knee.

BACKGROUND CONTEXT: In the last decade, the number of patients undergoing surgical treatment for lumbar spinal stenosis (LSS), particularly instrumented fusions, has significantly increased. The surgical procedures for LSS represent a significant cost to the health-care system and are a priority focus for most governments, insurers, hospital administrators, and spine care physicians. PURPOSE: The purpose of this study was to directly compare the relative improvement in self-reported quality of life after surgical intervention for matched groups of patients with primary hip or knee osteoarthritis (H-OA/K-OA) and focal lumbar spinal stenosis (FLSS). STUDY DESIGN/SETTING: Observational cohort study of prospectively collected outcomes. PATIENT SAMPLE: Patients, following elective primary one- to two-level spinal decompression (n=90) with (n=28/90) or without fusion for FLSS, were compared with a matched (age, sex, and time of surgery) cohort of patients who had undergone elective total hip (n=90) or total knee (n=90) arthroplasty (total joint arthroplasty [TJA]) for primary osteoarthritis. OUTCOME MEASURES: Medical Outcomes Study Short Form-36 (SF-36). METHODS: Patents were obtained for prospective outcomes databases (TJA and spine). Inclusion and exclusion criteria were independently applied, and matching was performed in a blinded fashion. The primary outcome measure was the relative change between preoperative and 2-year postoperative SF-36 questionnaires. Data were analyzed with the t test and repeated measures analysis of variance (ANOVA). RESULTS: The three groups (FLSS/H-OA/K-OA) were equally matched with respect to mean age (64/63/65 years), sex (female/male, 51/39 for all groups), body mass index (BMI) (27/24/27), and American Society of Anesthesiologists (ASA) physical status (2/2/2). Comparison of preoperative SF-36 physical component summary (PCS) scores and mental component summary (MCS) scores between groups showed no statistical difference (PCS: FLSS=32.0, H-OA=30.2, K-OA=31.3 [p=.32, ANOVA]/MCS: FLSS=43.5, H-OA=45.0, K-OA=46.2 [p=.25, ANOVA]). Postoperatively, PCS improved significantly for all groups (1 year-PCS: FLSS=39.6, H-OA=44.5, K-OA=38.5 [p<.0001 for all groups]; 2 years-PCS: FLSS=38.6, H-OA=43.2, K-OA=37.1 [p<.0001 for all groups]). At both 1- and 2-year follow-ups, the PCS improvement between groups was greater for the H-OA group compared with the FLSS (p=.0037, p=.0073) and K-OA (p=.00016, p=.00053) groups. At the 1-year follow-up, MCS did not significantly increase for any group; however, 2 years postoperatively, MCS improved significantly for the FLSS and H-OA groups (2 years-MCS: FLSS=50.3, H-OA=50.9, K-OA=44.8 [p=.00021, p=.00079, p=.35]). At the 1-year follow-up, there was no statistical difference in MCS improvement between groups (p=.45, ANOVA). Two years postoperatively, the MCS for both the FLSS and H-OA groups was significantly greater than that for the K-OA group (p=.0014, p=.00055). CONCLUSIONS: The results of this study show that surgical intervention for FLSS can obtain and maintain improvement in self-reported quality of life comparable to that of total hip and knee arthroplasty. This study provides data to support the need for prospective cost-effectiveness studies for the surgical management of appropriately selected patients suffering from FLSS.     

Are Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index Useful Predictors of Clinical Meaningful Improvement and Satisfaction After Total Hip Arthroplasty?

BackgroundUp to 15% of patients express dissatisfaction after total hip arthroplasty (THA). Preoperative patient-report outcome measures (PROMs) scores can potentially mitigate this by predicting postoperative satisfaction, identifying patients that will benefit most from surgery. The aim of this study was to (1) calculate the minimal clinically important difference (MCID) thresholds for Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) mental component summary (MCS) and physical component summary (PCS) scores and (2) identify the threshold values of these PROMs that could be used to predict patient satisfaction and expectation fulfilment.MethodsProspectively collected registry data of 1334 primary THA patients who returned for 2-year follow-up from 1998 to 2016 were reviewed. All patients were assessed preoperatively and postoperatively at 2 years using the OHS, WOMAC, and SF-36 PCS/MCS scores. The MCID for each PROMs was calculated, and the proportion of patients that attained MCID was recorded. The relationship between satisfaction, expectation fulfilment, and MCID attainment was analyzed using Spearman rank correlation. Optimal threshold scores for each PROM that predicted MCID attainment and satisfaction/expectation fulfilment at 2 years were calculated using receiver operating curve analysis.ResultsThe calculated MCID for OHS, WOMAC, SF-36 PCS, and SF-36 MCS were 5.2, 10.8, 6.7, and 6.2, respectively. A threshold value of 24.5 for the preoperative OHS was predictive of achieving WOMAC MCID at 2 years after THA (area under the curve 0.80, P < .001). 93.1% of patients were satisfied, and 95.5% had expectations fulfilled at 2 years. None of the PROMs were able to predict satisfaction.ConclusionOHS and WOMAC scores can be used to determine clinical meaningful improvement but are limited in their ability to predict patient satisfaction after THA.     

Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee—part 1: long-term change in health-related quality of life

Background contextIt is well accepted that total hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health-related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes with THA/TKA after surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome after LSS surgery compared with THA/TKA remains uncertain.PurposeThe primary purpose of this study is to assess whether improvements in HRQoL after surgical management of focal lumbar spinal stenosis (FLSS) with or without spondylolisthesis are sustainable over the long term compared with that of THA/TKA for OA.Study designSingle-center, retrospective, longitudinal matched cohort study of prospectively collected outcomes, with a minimum of 5-year follow-up (FU).Patient samplePatients who had primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary OA.Outcome measuresPostoperative change from baseline to last FU in Short-Form 36 physical component summary (PCS) and mental component summary (MCS) scores among groups was used as the primary outcome measure.MethodsAn age, sex-matched inception cohort of primary one- to two-level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared with a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was used for the primary analysis.ResultsMean (percent) FUs in months were 80.5+16.04 (79%), 94.6+16.62 (92%), and 80.6+16.84 (85%) for the FLSS, THA, and TKA cohorts, respectively, with a range of 5 to 10 years for all three cohorts. The number of patients who have undergone revision including those lost to FU for the FLSS, THA, and TKA cohorts were n=20 (20.2%, same site [n=7] and adjacent segment [n=13]) requiring 27 operations, n=3 (3%, same site) requiring 5 operations, and n=8 (8.1%, same site) requiring 12 operations, respectively (p<.01). The average time to first revision was 56/65/43 months, respectively. Mean postoperative PCS (p<.0001) and MCS (p<.02) scores improved significantly and were durable for all groups at the last FU. The mean changes from baseline PCS/MCS scores to last FU were 8.5/6.4, 12.3/7.0, and 8.3/4.9 for FLSS, THA, and TKA, respectively. Adjusting for baseline age, sex, body mass index, PCS score, and MCS score, there was a strong trend in favor of greater sustained change in the PCS score of THA over FLSS (p=.07) and TKA (p=.08). No difference was noted for change in PCS score between FLSS and TKA (p=.95). No differences were noted for change in MCS score among all three cohorts (p>.1).ConclusionsSignificant improvements in HRQoL after surgical treatment of FLSS with or without spondylolisthesis and hip and knee OA are sustained for a mean of 7 to 8 years, with a minimum of 5-year FU. Despite a higher revision rate, patients undergoing surgery for FLSS can expect a comparable long-term average improvement in HRQoL from baseline compared with their peers undergoing TKA and to a lesser extent THA.     

John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA

BackgroundDespite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery.Questions/purposesThe purpose of this study was to use preoperative patient-reported outcome measure (PROM) scores to predict which patients undergoing THA are most likely to experience a clinically meaningful change in functional outcome 1 year after surgery.MethodsA retrospective cohort study design was used to evaluate preoperative and 1-year postoperative SF-12 version 2 (SF12v2) and Hip Disability and Osteoarthritis Outcome Score (HOOS) scores from 537 selected patients who underwent primary unilateral THA. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. A receiver operating characteristic analysis was used to calculate threshold values, defined as the levels at which substantial changes occurred, and their predictive ability. MCID values for HOOS and SF12v2 physical component summary (PCS) scores were calculated to be 9.1 and 4.6, respectively. We analyzed the effect of SF12v2 mental component summary (MCS) scores, which measure mental and emotional health, on SF12v2 PCS and HOOS threshold values.ResultsThreshold values for preoperative HOOS and PCS scores were a maximum of 51.0 (area under the curve [AUC], 0.74; p < 0.001) and 32.5 (AUC, 0.62; p < 0.001), respectively. As preoperative mental and emotional health improved, which was reflected by a higher MCS score, HOOS and PCS threshold values also increased. When preoperative mental and emotional health were taken into account, both HOOS and PCS threshold values’ predictive ability improved (AUCs increased to 0.77 and 0.69, respectively).ConclusionsWe identified PROM threshold values that predict clinically meaningful improvements in functional outcome after THA. Patients with a higher level of preoperative function, as suggested by HOOS or PCS scores above the defined threshold values, are less likely to obtain meaningful improvement after THA. Lower preoperative mental and emotional health decreases the likelihood of achieving a clinically meaningful improvement in function after THA. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit after THA and to support the development of patient-based informed decision-making tools. For example, despite significant disease, patients with high preoperative function, as measured by PROM scores, may choose to delay surgery given the low likelihood of experiencing a meaningful improvement postoperatively. Similarly, patients with notably low MCS scores might best be counseled to address mental health issues before embarking on surgery.

Level of Evidence

Level III, prognostic study.     

Outcome after total hip arthroplasty: Comparison of a traditional disease-specific and a quality-of-life measurement of outcome

The purpose of this study was to examine the relationship between the Harris Hip Score (HHS), a traditional method of patient assessment of a total hip arthroplasty (THA), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a commonly used health-related quality-of-life survey. One hundred forty patients returning for routine clinical follow-up evaluation of a primary THA were asked to fill out the SF-36 quality-of-life survey, as well as questions concerning their perceptions of their THA. The patient's surgeon assessed the THA with the traditional HHS. The correlations between the HHS and the SF-36 domains were highest in the physical component summary scores for male patients of all ages and female patients 65 years of age or older. The correlations were lower for the mental component summary scores of all patients, but particularly in female patients younger than 65. When the SF-36 scores were compared with age and sex-matched population norms, both age and sex were found to be important. Men younger than 65 had scores lower than norms in the physical function domains, but were comparable in the mental health domains. The older men had scores comparable to the norms in all domains. Female patients of all ages, however, had lower scores in the physical function domains. The greatest differences were noted in the female patients younger than 65. The HHS is commonly used to assess disease-specific pain and function in THA patients; however, the results of this study suggest that the SF-36 health survey can capture additional important quality-of-life domains that are influenced by a THA and that these domains are influenced by the age and sex of the patient. The combination of a disease-specific scoring system and a quality-of-life survey would allow a more global assessment of a THA in all patients. Studies evaluating the results of THAs should either assess the results of male and female patients separately when sample size is sufficiently large or use sex as a possible covariate in a multivariate analysis.