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Clinically Relevant Threshold Achievement Evolves Over Time Following Primary Total Hip Arthroplasty.
Meredith F Cohen1, Elizabeth G Walsh1, Dharma H Patel1
1American Hip Institute Research Foundation, Chicago, Illinois.
The Journal of Arthroplasty
|March 18, 2026
Summary
Patient satisfaction after hip replacement increases over time, with more patients meeting the patient acceptable symptom state (PASS) at five years compared to two years. Minimum clinically important difference (MCID) achievement remained consistent.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Health Outcomes Research
Background:
- Patient-reported outcome thresholds are crucial for interpreting functional scores after total hip arthroplasty (THA).
- Defining the patient acceptable symptom state (PASS) and minimum clinically important difference (MCID) provides clinically relevant benchmarks for THA outcomes.
- This study establishes these thresholds for key patient-reported outcome measures (PROMs).
Purpose of the Study:
- To define the PASS and MCID for the modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Forgotten Joint Score (FJS).
- To identify changes in the achievement rates of these thresholds over time (two vs. five years post-THA).
Main Methods:
- Retrospective review of 221 patients undergoing primary THA with complete two- and five-year follow-up data.
- Utilized anchor questions for mHHS, VAS, and HOOS-JR, alongside the FJS, to determine PASS thresholds via Receiver Operating Characteristic (ROC) curves.
- Employed the distribution method to calculate MCID for mHHS and VAS.
Main Results:
- At two years, PASS achievement rates were: mHHS 76%, HOOS-JR 85.5%, FJS 89.1%, and VAS 84.6%.
- At five years, PASS achievement rates increased: mHHS 86.4%, HOOS-JR 91.0%, FJS 86.9%, and VAS 83.3%.
- Significantly more patients achieved PASS at five years versus two years for mHHS (P < 0.01); MCID achievement rates were similar between time points for mHHS and VAS.
Conclusions:
- Achievement of the patient acceptable symptom state (PASS) improves from two to five years post-THA.
- While functional demands may decrease with age (lower PASS thresholds), patient satisfaction demonstrably increases.
- No significant changes in minimum clinically important difference (MCID) achievement rates were observed between the two and five-year follow-up points.
