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How Much Perioperative Pain and Dysfunction Underlie the HOOS JR and KOOS JR?

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The Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) scores offer insights into pain and function after surgery. A change of approximately 30 points indicates significant improvement in pain and daily activities.

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Area of Science:

  • Orthopedic surgery outcomes research
  • Patient-reported outcome measures in joint replacement

Background:

  • The Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) scores range from 0 to 100, but lack clear interpretation for intermediate values.
  • Understanding pain and function levels is crucial, especially within the first 90 days post-surgery, to identify care improvement opportunities.

Purpose of the Study:

  • To determine the meaning of preoperative and postoperative HOOS JR and KOOS JR scores regarding pain and daily function.
  • To establish the score change (delta) required for significant improvement in pain control and daily functioning after joint replacement surgery.

Main Methods:

  • A retrospective analysis of 8,525 patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI).
  • Patient-reported outcomes were categorized into four pain-function groups using dichotomized PROMIS-10 pain and function items.
  • Adjusted mean HOOS JR and KOOS JR scores were calculated for each category, and the delta for improvement was determined using multivariable logistic regression.

Main Results:

  • Preoperative mean scores for the least favorable pain/function category were approximately 40 for both HOOS JR and KOOS JR.
  • The most favorable pain/function category showed mean scores around 60 for HOOS JR and 59 for KOOS JR.
  • An adjusted delta of 30 for HOOS JR and 27 for KOOS JR indicated significant improvement in pain or function.

Conclusions:

  • The study provides context for interpreting HOOS JR and KOOS JR scores and their associated pain/function levels.
  • Tracking the proportion of patients achieving a sufficient delta (approx. 30 points) could inform quality improvement initiatives.
  • Further research is needed to understand long-term score changes and subgroup differences.