Defining Patient Acceptable Symptom State for Primary Total Hip Arthroplasty: A 10-Year Follow-Up Study

Statistical improvement in patient-reported outcomes (PROs) does not necessarily equate to clinical benefit. Clinometric outcome thresholds have been used to provide a better insight into postoperative functional status and patient satisfaction in total hip arthroplasty (THA). This study aimed to define and evaluate patient acceptable symptomatic state (PASS) at the 10-year follow-up time point for modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), and Forgotten Joint Score (FJS).

Prospectively collected data were retrospectively reviewed for all patients who underwent primary THA between 2008 and 2015. Patients were included in the study if they had complete PROs with anchor questions at the 10-year time point. The PASS thresholds were then defined using the anchor-based method for mHHS, HHS, HOOS-JR, and FJS. A total of 176 hips were included in the study, with 101 women (57.4%). The average age, body mass index, and follow-up time were 58 ± 8.2 years, 29.4 ± 5.1, and 124.9 ± 6.9 months, respectively.

The areas under the curves were as follows: mHHS 0.87, HHS 0.87, HOOS-JR 0.87, and FJS 0.71, indicating acceptable to excellent discrimination for all defined thresholds. The threshold for achieving PASS at 10-year follow-up was as follows: mHHS 79.5, HHS 81.3, HOOS-JR 75.1, and FJS 76.0.

This study establishes the PASS thresholds for mHHS, HHS, HOOS-JR, and FJS at the 10-year follow-up time point following primary THA. These findings offer clinicians valuable reference points for assessing clinical success over the long term.