Toward Understanding the Differences Between Satisfaction and Improvement After Primary Total Hip Arthroplasty

Area of Science:

• Orthopedics
• Patient-Reported Outcomes
• Health Services Research

Background:

• Patient satisfaction is a common metric for assessing total hip arthroplasty (THA) outcomes.
• The Centers for Medicare & Medicaid Services (CMS) defines substantial clinical benefit (SCB) as a 22-point increase in the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) at one year.
• Understanding the distinction between patient satisfaction and objective improvement is crucial.

Purpose of the Study:

• To evaluate self-reported patient satisfaction after THA.
• To compare patient satisfaction with the achievement of the CMS-defined SCB using the HOOS JR score at one-year follow-up.
• To identify factors associated with HOOS JR score improvement.

Main Methods:

• A cohort of 2,138 THA patients was analyzed, with data collected preoperatively and at one-year follow-up.
• Patients completed the HOOS JR and PROMIS Global Health surveys.
• Satisfaction was assessed via a binary yes/no question; multivariable regressions analyzed associations between demographics, preoperative PROMs, and HOOS JR changes/SCB achievement.

Main Results:

• 96% of patients reported satisfaction with THA at one year.
• The mean HOOS JR score improvement was 35 points, with 78% achieving the CMS SCB.
• Lower preoperative HOOS JR scores, younger age at surgery, and higher preoperative PROMIS Physical scores correlated with greater HOOS JR improvement and SCB achievement.

Conclusions:

• While THA demonstrates high patient satisfaction rates, a significant portion of patients may not meet the CMS SCB criteria based on HOOS JR scores.
• Healthcare providers should clarify the difference between satisfaction and improvement when counseling patients regarding THA outcomes.
• This highlights the importance of using objective measures alongside patient-reported satisfaction.