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

Abstract

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. 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. 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. 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.