PMID- 31136425
OWN - NLM
STAT- MEDLINE
DCOM- 20200312
LR  - 20200601
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Print)
IS  - 0009-921X (Linking)
VI  - 477
IP  - 6
DP  - 2019 Jun
TI  - What Preoperative Factors are Associated With Not Achieving a Minimum Clinically 
      Important Difference After THA? Findings from an International Multicenter Study.
PG  - 1301-1312
LID - 10.1097/CORR.0000000000000667 [doi]
AB  - BACKGROUND: Despite innovations in THA, there remains a subgroup of patients who 
      experience only modest pain relief and/or functional improvement after the 
      procedure. Although several studies have previously sought to identify factors 
      before surgery that were associated with achieving or not achieving a meaningful 
      improvement after THA, there is no consensus on which factors are most 
      associated; many studies have relied on single-center or single-country 
      multicenter studies for their cohorts. QUESTIONS/PURPOSES: We sought to identify 
      (1) the proportion of patients who do not achieve a minimum clinically important 
      difference (MCID) in pain and function 1 year after THA, and (2) the preoperative 
      factors that were associated with not achieving MCIDs in pain and function 1 year 
      after THA. METHODS: This retrospective study analyzed data gathered from a 
      prospective international, multicenter study examining the long-term clinical 
      outcomes of two different polyethylene liners and two different acetabular 
      shells. A total of 814 patients from 12 centers across four countries were 
      enrolled in the study, with the final cohort consisting of 594 patients (73%) who 
      all had complete preoperative and 1-year PROMs as well as a valid preoperative 
      radiograph used to measure minimum joint space width. The outcomes in this study 
      were achieving evidence-derived MCIDs in (1) pain, defined as a reduction of two 
      points on an 11-point (0 = very little, 10 = worst imaginable) numerical rating 
      scale (NRS) for hip-related pain or reporting a 1 year NRS-pain score of 0, and 
      (2) function, defined as an increase equal to or greater than 8.3 on the SF-36 
      Physical Function subscore (range: 0 to 100; 0 = maximum disability, 100 = no 
      disability) or reporting a 1-year SF-36 Physical Function subscore within the 
      95th percentile of scores in our cohort. All demographic variables, such as age, 
      sex, country; surgical factors, including body mass index (BMI), surgical 
      approach, acetabular liner type, and preoperative PROMs, were included as 
      covariates in a binary logistic regression model. We used a backwards stepwise 
      elimination algorithm to reach the simplest, best-fit model. RESULTS: In the 
      final analysis cohort of 594 patients, 54 patients (9%) did not achieve the MCID 
      in pain and 146 (25%) patients did not achieve the MCID in physical function 
      after THA. After controlling for potential confounding variables such as age, 
      BMI, and preoperative PROMs, we found that higher joint space width (odds ratio 
      (OR) = 2.19; 95% confidence interval (CI) = 1.49-3.22; p < 0.001), lower 
      preoperative SF-36 Mental Component Summary (MCS) (OR = 0.95; 95% CI = 0.93-0.98; 
      p = 0.001), and female sex (OR = 2.04; 95% CI = 1.08-3.82; p = 0.027) were 
      associated with failing to achieve a MCID in pain. It is important to note that 
      the effect size of having a higher preoperative SF-36 MCS is small, with a 1- or 
      10-point increase in SF-36 MCS decreasing the odds of a patient not achieving the 
      pain MCID by 5% or 63%, respectively.In a separate multivariable model, after 
      controlling for potential confounding variables such as age, BMI, and 
      preoperative PROMs, we found that higher joint space width (OR = 1.54; 95% CI = 
      1.18-2.02; p = 0.002), higher preoperative Harris hip score (HHS) (OR = 1.01; 95% 
      CI = 1.00-1.03; p = 0.019) and undergoing surgery in Scandinavia (OR = 1.73; 95% 
      CI = 1.17-2.55; p = 0.006) were associated with failing to achieve a MCID in 
      physical function. It is important to note that the effect size of having a 
      higher preoperative HHS is very small, with a 1- or t10-point increase in HHS 
      increasing the odds of not achieving the physical function MCID by only 1% or 
      15%, respectively. CONCLUSIONS: These findings suggest that surgeons should 
      counsel patients with high joint space width, female patients, and patients 
      undergoing surgery in Scandinavia that they may be much less likely to experience 
      meaningful pain relief or functional improvement after THA, and in light of that, 
      determine whether indeed surgery should be postponed or avoided in those 
      patients. Lower SF-36 MCS score and higher HHS before surgery were also found to 
      be associated with not achieving MCIDs in pain and physical function, 
      respectively, after surgery, but both had relatively small effect sizes. Future 
      prospective studies may consider exploring the relationship between less pain 
      relief or functional improvement and the risk factors identified in this study, 
      such as high joint space width, to validate our findings and determine if the 
      variables we identified are truly predictive of worse postoperative outcomes. 
      Future retrospective studies of regional or national registry data should use the 
      analysis methods presented within this study to both identify the portion of the 
      THA patients who do not achieve a MCID in pain or physical function after surgery 
      and confirm if the preoperative risk factors for poor improvement identified 
      within our international, multicenter cohort are also found in a larger patient 
      population with more diverse implants and comorbidities. LEVEL OF EVIDENCE: Level 
      III, therapeutic study.
FAU - Rojanasopondist, Pakdee
AU  - Rojanasopondist P
AD  - P. Rojanasopondist, V. P. Galea , J. W. Connelly , S. J. Matuszak, C. R. Bragdon, 
      H. Malchau, Harris Orthopaedics Laboratory, Massachusetts General Hospital, 
      Boston, MA, USA O. Rolfson, Department of Orthopaedics Institute of Clinical 
      Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
FAU - Galea, Vincent P
AU  - Galea VP
FAU - Connelly, James W
AU  - Connelly JW
FAU - Matuszak, Sean J
AU  - Matuszak SJ
FAU - Rolfson, Ola
AU  - Rolfson O
FAU - Bragdon, Charles R
AU  - Bragdon CR
FAU - Malchau, Henrik
AU  - Malchau H
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - IM
CIN - Clin Orthop Relat Res. 2019 Jun;477(6):1313-1314. PMID: 31136426
MH  - Adult
MH  - Aged
MH  - *Arthroplasty, Replacement, Hip
MH  - Disability Evaluation
MH  - Female
MH  - *Hip Prosthesis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Minimal Clinically Important Difference
MH  - Pain Measurement
MH  - *Patient Reported Outcome Measures
MH  - Prosthesis Design
MH  - Quality of Life
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Scandinavian and Nordic Countries
PMC - PMC6554138
COIS- All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and 
      Related Research(R) editors and board members are on file with the publication and 
      can be viewed on request.
EDAT- 2019/05/29 06:00
MHDA- 2020/03/13 06:00
PMCR- 2020/06/01
CRDT- 2019/05/29 06:00
PHST- 2019/05/29 06:00 [entrez]
PHST- 2019/05/29 06:00 [pubmed]
PHST- 2020/03/13 06:00 [medline]
PHST- 2020/06/01 00:00 [pmc-release]
AID - 00003086-201906000-00011 [pii]
AID - CORR-D-18-01228 [pii]
AID - 10.1097/CORR.0000000000000667 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2019 Jun;477(6):1301-1312. doi: 
      10.1097/CORR.0000000000000667.