ABSTRACT
Background: The purpose of the present study was to investigate the relationship between socioeconomic status and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) scores before and after primary total knee arthroplasty (TKA). We hypothesized that patients with greater social deprivation would have lower PROMIS-GH scores at 3 months and 1 year following primary TKA. Methods: We retrospectively reviewed data from patients who underwent unilateral primary TKA and completed PROMIS-GH preoperatively and at 3 months (n = 257) or 1 year (n = 154) postoperatively. Area Deprivation Index (ADI), calculated from 9-digit zip codes, was used to measure social deprivation. Participants were grouped into quartiles by ADI score. Minimal clinically important difference in PROMIS-GH mental (PROMIS-MH) and physical health (PROMIS-PH) component scores were compared between ADI groups. Results: Participants in the highest ADI quartile (most disadvantaged) had significantly lower PROMIS-MH and PROMIS-PH scores at every time point relative to the lowest ADI quartile (least disadvantaged) (P < .05 for all). Both ADI groups experienced significant improvements in PROMIS-PH following TKA (P < .001 for all), but not in PROMIS-MH (P > .05 for all) at 3-months and 1-year postoperatively. Magnitude of improvement in PROMIS-PH and rates of achievement of minimal clinically important difference did not significantly differ between ADI groups (P > .05 for all). Conclusions: Socially disadvantaged patients benefit equally from primary TKA but are more likely to have persistently lower 1-year postoperative PROMIS-GH scores relative to less disadvantaged patients. Social deprivation should be accounted for when using PROMIS-GH to assess clinical outcomes for research and quality measures. Level of Evidence: IV, retrospective cohort study.
ABSTRACT
Background: Clinical outcomes following primary total hip arthroplasty (THA) are commonly assessed through patient-reported outcome measures (PROM). The purpose of this study was to use progressively more stringent definitions of success to evaluate clinical outcomes of primary THA at 1-year postoperatively and to determine if demographic variables were associated with achievement of clinical success. Methods: The American Joint Replacement Registry (AJRR) was queried from 2012-2020 for primary THA. Patients that completed the following PROMs preoperatively and 1-year postoperatively were included: Western Ontario and McMaster Universities Arthritis Index (WOMAC), Hip Injury and Osteoarthritis Outcome Score (HOOS) and HOOS for Joint Replacement (HOOS, JR). Mean PROM scores were determined for each visit and between-visit changes were evaluated using paired t-tests. Rates of achievement of minimal clinically important difference (MCID) by distribution-based and anchor-based criteria, patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) were calculated. Logistic regression was used to evaluate associations between demographic variables and odds of success. Results: 7,001 THAs were included. Mean improvement in PROM scores were: HOOS, JR, 37; WOMAC-Pain, 39; WOMAC-Function, 41 (p<0.0001 for all). Rates of achievement of each metric were: distribution-based MCID, 88-93%; anchor-based MCID, 68-90%; PASS, 47-84%; SCB, 68-84%. Age and sex were the most influential demographic factors on achievement of clinical success. Conclusion: There is significant variability in clinical outcomes at 1 year after primary THA when using a tiered approach to define success from the patient's perspective. Tiered approaches to interpretation of PROMs should be considered for future research and clinical assessment. Level of Evidence: III.
