Toward Understanding the Differences Between Satisfaction and Improvement After Primary Total Hip Arthroplasty
Jacqueline R Ray1, Christopher M Jaicks1, Henry Ho1
1Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Background:
While satisfaction is often used by clinicians to assess outcomes after primary total hip arthroplasty (THA), the Centers for Medicare & Medicaid Services (CMS) has defined a 22-point increase in the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) at 1-year follow-up as their improvement metric representing a substantial clinical benefit (SCB). To better understand the differences between satisfaction and improvement, this study evaluated self-reported patient satisfaction and HOOS JR score changes at 1-year follow-up.
Methods:
We identified 2,138 THAs performed from October 2020 to August 2024 among patients who completed the HOOS JR and the Patient-Reported Outcomes Measurement Information System Global Health surveys at preoperative and 1-year follow-up intervals. These patients also responded to a binary yes/no question asking if they were satisfied with their THA at 1-year follow-up. The mean age at surgery was 67 years (range, 19 to 94 years), and 59% (1,262 of 2,138) of THAs were performed among women. Multivariable regressions were used to assess how patient demographics and preoperative patient-reported outcome measures were associated with HOOS JR score changes and whether the 22-point CMS SCB was achieved.
Results:
At 1-year follow-up, 96% (2,048 of 2,138) of patients reported that they were satisfied, while the mean improvement in HOOS JR scores was 35 (range, -32 to 100) and 78% (1,658 of 2,138) of THAs achieved the CMS SCB. Multivariable analyses indicated that lower preoperative HOOS JR scores, decreases in age at surgery, and higher preoperative Patient-Reported Outcomes Measurement Information System Global Health Physical scores were associated with increased changes in the HOOS JR score and a greater likelihood of achieving the CMS SCB.
Conclusions:
Although THA has high rates of self-reported patient satisfaction, the frequency of patients achieving the CMS SCB based on the HOOS JR can be considerably lower. Health-care providers will need to discuss the difference between satisfaction and improvement when counseling their patients.
