Arthroplasty Today最新文献

{"title":"Is Robotic-Assisted Unicompartmental Knee Arthroplasty Compared to Manual Unicompartmental Knee Arthroplasty Associated With Decreased Revision Rates? An Updated Matched Cohort Analysis","authors":"George Guild MD ,&nbsp;Joseph Schwab MD ,&nbsp;Bailey J. Ross MD ,&nbsp;Mary Jane McConnell BS ,&nbsp;Farideh Najafi MD ,&nbsp;Thomas L. Bradbury MD","doi":"10.1016/j.artd.2025.101652","DOIUrl":"10.1016/j.artd.2025.101652","url":null,"abstract":"<div><h3>Background</h3><div>Despite increased utilization of robotic assistance during unicompartmental knee arthroplasty (UKA), its impact on postoperative outcomes remains unclear. This study aimed to compare rates of postoperative revision and complications among patients undergoing robotic-assisted UKA (RA-UKA) versus manual UKA.</div></div><div><h3>Methods</h3><div>A retrospective matched cohort study was performed. Trends analysis of the annual proportion of RA-UKA between 2010 and 2021 was performed, and RA-UKA patients (n = 3976) were matched 1:3 with manual UKA patients (n = 11,766) across age, sex, Elixhauser Comorbidity Index, and comorbidities. Rates of 2-year prosthesis-related complications were compared between the matched cohorts using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The annual proportion of UKA procedures performed with robotic assistance trended significantly upward (1.51% to 5.19%, <em>P</em> &lt; .001). Within 2 years postoperatively, the RA-UKA cohort exhibited significantly lower rates of aseptic revision (1.84% vs 2.37%; odds ratio: 0.76; <em>P</em> = .040) and aseptic loosening (0.13% vs 0.42%; odds ratio: 0.32; <em>P</em> = .010). Total cost for the index UKA was significantly higher for the RA-UKA cohort ($10,321 vs $7,366; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>There has been a marked increase in utilization of RA-UKA. Compared to matched manual UKA, RA-UKA had lower rates of revision and aseptic loosening at 2-year follow-up, but at a higher total cost for the index procedure. Further research exploring the use of robotics in UKA with attention to patient outcomes and cost is crucial for defining its evolving role in orthopaedic surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101652"},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One High-Volume Posteromedial Knee Capsular Injection Can Provide Safe Anesthetic Infiltration Across the Entire Posterior Knee Capsule","authors":"Ran Atzmon MD ,&nbsp;Landon Polakof MD ,&nbsp;Adam Wang PhD ,&nbsp;Seth Sherman MD ,&nbsp;Nicholas John Giori MD, PhD","doi":"10.1016/j.artd.2025.101651","DOIUrl":"10.1016/j.artd.2025.101651","url":null,"abstract":"<div><h3>Background</h3><div>Anesthetic injection through the central or posterolateral knee capsule for analgesia after knee surgery risks popliteal vessel and tibial and peroneal nerve injury. We evaluated the distribution of a high volume of fluid injected through only the posteromedial capsule and compared it to a technique involving injections through the posteromedial and posterolateral capsules.</div></div><div><h3>Methods</h3><div>Four fresh cadaveric knees were injected with 50 ml of Omnipaque 350 diluted 1:4 with normal saline through the posteromedial knee capsule. In four other specimens, we followed a published protocol by injecting 12.5 ml posteromedially and 12.5 ml posterolaterally. The knees were then ranged 20 times over 20 minutes before obtaining a computed tomography scan to evaluate the spread of injected contrast fluid.</div></div><div><h3>Results</h3><div>Both techniques demonstrated broad distribution of injected fluid posterior to the capsule. An average of 80% of the capsular width at the level of the injection was within 5 mm of the injected contrast with the single injection, while 63% was with the two-injection technique.</div></div><div><h3>Conclusions</h3><div>One 50 mL injection through the posteromedial knee capsule can provide broad medial, lateral, superior, and inferior distribution of anesthetic without risking injury to neurovascular structures. This has become our preferred method of anesthetizing the posterior knee during knee surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101651"},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Dimensional Preoperative Digital Templating is Less Accurate When Using a Collared Triple Taper Stem Versus a Single Taper Design","authors":"Claudio Diaz-Ledezma MD ,&nbsp;Angel X. Xiao MD, MSE ,&nbsp;Juan David Lizcano MD ,&nbsp;Erik N. Hansen MD ,&nbsp;Camilo Restrepo MD ,&nbsp;William J. Hozack MD","doi":"10.1016/j.artd.2025.101658","DOIUrl":"10.1016/j.artd.2025.101658","url":null,"abstract":"<div><h3>Background</h3><div>Collared triple taper stems (CTTS) and single taper stems (STS) have an excellent performance in primary total hip arthroplasty (THA). While 2-dimensional radiographic templating is accurate for STS, data are lacking for CTTS. We hypothesize that CTTS’ more anatomical design in the anteroposterior dimension may lead to inaccurate templating sizing. This study compared templating accuracy of CTTS to a predecessor STS in THA patients.</div></div><div><h3>Methods</h3><div>106 THA performed with CTTS were compared to 106 THA performed with STS by 2 high-volume surgeons. The stems chosen for comparison were manufactured by the same company, use the same templating software, shared an identical medial-lateral profile, and offered the same size range. The ability of digital templating to predict final implant size was evaluated.</div></div><div><h3>Results</h3><div>Template to stem accuracy was 36.8% for CTTS and 49.1% for STS (<em>P</em> = .07). Accuracy within 1 size was 88.7% for CTTS versus 95.2% for STS (<em>P</em> = .1). CTTS was implanted using a smaller size compared to the template twice as frequently as STS (43.4% vs 20.8%; <em>P</em> &lt; .01). CTTS was 3.7 times more likely to have implants 2 or more sizes under the template compared to STS (10.4% vs 2.8%; <em>P</em> = .02). In logistic regression, the only predictor of implant 2+ sizes under the template was type of stem (<em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>The accuracy of conventional templating for CTTS is lower than the predecessor STS, with the template often suggesting a larger size. Bi-planar or 3-dimensional preoperative templating could potentially be a more accurate technique, especially during the initial learning curve with these stems.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101658"},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administration of a Methylprednisolone Taper and Complication Rates Following Total Knee Arthroplasty: A Multicenter Retrospective Study","authors":"Andrew A. Fuqua BS ,&nbsp;Sean H. Gordon BS ,&nbsp;Anoop S. Chandrashekar BS ,&nbsp;Bridger Rodoni MD, MBA ,&nbsp;Thea Xerogaenes ,&nbsp;Ryan Martin MD ,&nbsp;James Roberson MD ,&nbsp;Gregory Polkowski MD, MSc ,&nbsp;Jacob M. Wilson MD ,&nbsp;Ajay Premkumar MD, MPH","doi":"10.1016/j.artd.2024.101603","DOIUrl":"10.1016/j.artd.2024.101603","url":null,"abstract":"<div><h3>Background</h3><div>Most patients undergoing total knee arthroplasty (TKA) report moderate to severe pain in the acute postoperative period. Recent preliminary data have suggested that a short course of oral corticosteroid may improve early postoperative pain after various orthopedic operations, but the safety of this practice has not been rigorously evaluated in larger patient populations. The purpose of this study was to evaluate complication rates in patients receiving a methylprednisolone taper (MT) vs controls after primary TKA.</div></div><div><h3>Methods</h3><div>Records were reviewed for patients undergoing primary TKA from 2018 to 2023 by 2 surgeons at different institutions who began routinely prescribing a 6-day MT to patients without a contraindication or poorly controlled diabetes. The primary outcome of periprosthetic joint infection at 90 days and final follow-up was assessed as were secondary outcomes of surgical site infection and wound complications. A total of 930 patients were included in the study, with 641 patients in the control cohort and 289 patients in the methylprednisolone cohort.</div></div><div><h3>Results</h3><div>There were no significant differences between the methylprednisolone and control cohorts in 90-day periprosthetic joint infection (0.7% vs 0%, <em>P</em> = .1, respectively), surgical site infection (1.0% vs 1.4%, <em>P</em> = .4, respectively), or wound complication (1.0% vs 2.0%, <em>P =</em> .4, respectively). There were no significant differences in any complication at final follow-up.</div></div><div><h3>Conclusions</h3><div>MT following TKA did not significantly increase rates of wound complications or infections in this multi-institutional retrospective cohort study. This study provides preliminary evidence regarding the safety profile of a short duration of postoperative oral corticosteroids following TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101603"},"PeriodicalIF":1.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis","authors":"Simarjeet Puri MD ,&nbsp;Martin Weaver MD ,&nbsp;Lisheng Chen PhD ,&nbsp;Tae Kim MHSA ,&nbsp;Elizabeth Dailey MD ,&nbsp;David C. Markel MD","doi":"10.1016/j.artd.2025.101659","DOIUrl":"10.1016/j.artd.2025.101659","url":null,"abstract":"<div><h3>Background</h3><div>Total joint arthroplasty is shifting from hospitals to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). A Michigan Arthroplasty Registry Quality Collaborative Initiative quality improvement project examined readmissions, emergency room (ER) visits, periprosthetic joint infection (PJI), fracture, and dislocation after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) across sites.</div></div><div><h3>Methods</h3><div>Primary TJAs between July 1, 2021, and June 30, 2022 (N = 41,696: 3910 ASC, 1,834 HOPD, and 35,952 hospital) were reviewed. Of 17,100 THAs, 9.5% (1,631) were at ASCs, 4.7% (798) at HOPDs, and 85.8% (14,671) at hospitals. Of 24,596 TKAs, 9.3% (2,279) were at ASC, 4.2% (1,036) at HOPDs, and 86.5% (21,281) at hospitals. Hospitals treated more elderly, women, non-White, obese, diabetics, smokers, and governmental insurance.</div></div><div><h3>Results</h3><div>For THAs, ASCs had the lowest 30-day (ASC 1%, HOPD 1.8%, hospital 3.4%, <em>P</em> &lt; .001) and 90-day (ASC 1.7%, HOPD 3.4%, hospital 5.5%, <em>P</em> &lt; .001) readmissions, 30-day ER visits (ASC 1.8%, HOPD 3.5%, hospital 5.3%, <em>P</em> &lt; .001), and fractures (ASC 0.4%, HOPD 0.6%, hospital 1.2%, <em>P</em> &lt; .001). Similar trends were observed for TKAs: 30-day readmissions (ASC 1.3%, HOPD 1.4%, hospital 3.1%, <em>P</em> &lt; .001), 90-day readmissions (ASC 2.2%, HOPD 2.3%, hospital 5.2%, <em>P</em> &lt; .001), and 30-day ER visits (ASC 3%, HOPD 6.5%, hospital 6.4%, <em>P</em> &lt; .001). PJI (THA: <em>P</em> = .1, TKA: <em>P</em> = .6) and dislocation rates (<em>P</em> = .5) were similar across sites.</div></div><div><h3>Conclusions</h3><div>Patients receiving primary total joint arthroplasty at an ASC had the least postoperative hospital-based care despite similar rates of PJI and dislocation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101659"},"PeriodicalIF":1.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin for Venous Thromboembolism Prophylaxis and Nonsteroidal Anti-inflammatory Agents Should Be Administered at Least 2 Hours Apart","authors":"Matthew J. Grosso MD","doi":"10.1016/j.artd.2025.101663","DOIUrl":"10.1016/j.artd.2025.101663","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101663"},"PeriodicalIF":1.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suction-Powered Intramedullary Bone Debridement Technology Compared to Conventional Curettage in Infected Revision Total Knee Arthroplasty","authors":"Joshua Hansen MD,&nbsp;Alexis Sandler MD,&nbsp;Michael Polmear MD,&nbsp;Richard Purcell MD","doi":"10.1016/j.artd.2025.101648","DOIUrl":"10.1016/j.artd.2025.101648","url":null,"abstract":"<div><h3>Background</h3><div>Revision total knee arthroplasty (TKA) in the United States is an increasingly common procedure, often performed in the setting of prosthetic joint infection. Debridement of the intramedullary canals is traditionally performed with surgical curettes and is technically difficult and time-intensive. A suction-powered bone harvester (SPBH) is designed to improve the quality of debridement in a closed-capture system. This study assesses conventional curettage (CC) versus SPBH in debridement mass and time from intramedullary spaces. We hypothesize that SPBH will increase debridement yield more efficiently than conventional curettes.</div></div><div><h3>Methods</h3><div>Adult patients undergoing revision TKA were enrolled to participate in the study and were divided into 2 groups. Patients in group 1 received tibial debridement with CC followed by SPBH and femoral canals with SPBH alone. Patients in group 2 received femoral debridement with CC followed by SPBH and tibial canals with SPBH alone.</div></div><div><h3>Results</h3><div>Data were collected from 30 revision TKA cases in the setting of prosthetic joint infection. In total, 14 femora and 16 tibiae were initially debrided with SPBH, while the opposites were debrided with CC. On average, the intramedullary debridement with SPBH yielded 23.1 g compared to 13.2 g with CC (<em>P</em> = .0017). The intramedullary canal required 1 minute 28 seconds for debridement with SPBH compared to 2 minutes for debridement with CC (<em>P</em> = .0347). Culture data from samples obtained from SPBH were noninferior to CC.</div></div><div><h3>Conclusions</h3><div>SPBH is an effective tool for debridement of intramedullary canal during revision TKA. SPBH led to a significant increase of debrided mass in significantly less time than CC. There was no difference in positive culture yield between the 2 debridement techniques. This debridement technique merits consideration to reduce bioburden in revision TKA.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101648"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic and Clinical Outcomes After Direct Anterior Versus Mini Posterior Total Hip Arthroplasty","authors":"David A. Hamilton MD ,&nbsp;Colin A. McNamara MD, MBA ,&nbsp;Austin E. Wininger MD ,&nbsp;Thomas C. Sullivan BS ,&nbsp;Bradley S. Lambert PhD ,&nbsp;Stephen J. Incavo MD ,&nbsp;Kwan J. Park MD","doi":"10.1016/j.artd.2025.101650","DOIUrl":"10.1016/j.artd.2025.101650","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is a successful surgical treatment for end-stage hip arthritis. There is controversy over whether the surgical approach leads to any differences in implant sizing, implant positioning, and clinical outcomes. This study sought to compare radiographic and clinical outcomes when performing primary THA through the direct anterior approach (DAA) and posterior approach (PA).</div></div><div><h3>Methods</h3><div>In this retrospective cohort study of patients undergoing primary THA, 198 DAA patients were matched to 198 PA patients. Surgeries were performed by 3 fellowship-trained surgeons. Radiographic parameters analyzed were acetabular cup anteversion and abduction angles, femoral stem coronal alignment, femoral offset, and leg-length discrepancy. Postoperative complications, including periprosthetic joint infection, wound complications, periprosthetic fracture, and dislocation, were extracted from the medical record. Statistical analysis was performed to compare radiographic and clinical outcomes between groups.</div></div><div><h3>Results</h3><div>There were no statistically significant differences for any postoperative complications between the 2 groups. One dislocation occurred in the PA group, and no dislocations occurred in the DAA group. DAA had a longer operative time (117 vs 79 minutes, <em>P</em> &lt; .01). PA had a higher increase in femoral offset compared to the contralateral limb (2.76 mm vs 1.01 mm, <em>P</em> &lt; .01), higher cup anteversion (26.17° vs 23.44°, <em>P</em> &lt; .001), and higher use of dual mobility components (6.06% vs 1.01%, <em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Both DAA and PA lead to acceptable clinical and radiographic outcomes for primary THA, with significant differences noted for cup position, femoral offset, and use of dual mobility components. These differences likely represent surgeon factors to help mitigate the risk for dislocation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101650"},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of Loose Bodies From the Posterior Aspect of the Knee During Total Knee Arthroplasty: A Technical Note","authors":"Zachary J. Sirois MD,&nbsp;Vibhatsu Amin MD,&nbsp;Robert Steensen MD","doi":"10.1016/j.artd.2025.101653","DOIUrl":"10.1016/j.artd.2025.101653","url":null,"abstract":"<div><div>In planning total knee arthroplasty (TKA), preoperative radiographs may show calcific bodies in the posterior soft tissues of the knee. We describe a technique in which they can be removed without making a separate skin incision during TKA after femoral and tibial bone resection. This technique involves probing the posteromedial capsule with a clamp to identify the opening to a popliteal cyst. Once identified, the opening is tensioned and incised to allow removal of the loose bodies. If retained, these loose bodies can be a source of patient dissatisfaction, particularly since they are sometimes palpable to the patient. This is the first technique to describe removal of such loose bodies during routine TKA without an additional incision.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101653"},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Clinically Meaningful Thresholds for 12-Month Patient-Reported Outcomes in Total Hip Arthroplasty; Toward Improving Threshold Accuracy","authors":"Julia E.J.W. Geilen MD ,&nbsp;Thomay-Claire A. Hoelen MSc ,&nbsp;Martijn G.M. Schotanus PhD ,&nbsp;Wouter L.W. van Hemert MD, PhD ,&nbsp;Anneke Spekenbrink-Spooren MSc ,&nbsp;Bert Boonen MD, PhD ,&nbsp;Jasper Most PhD","doi":"10.1016/j.artd.2025.101649","DOIUrl":"10.1016/j.artd.2025.101649","url":null,"abstract":"<div><h3>Background</h3><div>Clinically meaningful thresholds for patient-reported outcomes are relevant to define and predict success of total hip arthroplasties (THAs). Defining and offering thresholds must consider preoperative symptom severity.</div></div><div><h3>Methods</h3><div>In this retrospective study of 40,213 primary total hip replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes and patient-acceptable symptom states with the anchor transition in function. Subgroups were identified for which independent thresholds should be defined. Patient-reported outcome measures were symptoms (pain, Oxford Hip Score [OHS], Hip disability and Osteoarthritis Outcome Score) and quality of life (European Quality of Life 5 Dimensions 3L questionnaire).</div></div><div><h3>Results</h3><div>94.6% completed the anchor questions, of whom 80.1% reporting “much improved function” 1 year after surgery. Discriminative abilities of thresholds were not good (area under the curve &lt; 0.8). Tercile-specific determination of thresholds improved discrimination and reliability (+10%). Minimal clinically important change values were higher for all outcomes (eg, change in OHS ≥ 24.5 vs ≥ 10.5) in patients with more severe preoperative symptoms. Patient-acceptable symptom state scores for European Quality of Life 5 Dimensions index (≥ 0.809) and OHS (≥ 40.5) showed good discrimination (area under the curve &gt; 0.8). Patients with less symptoms required lower postoperative scores for reporting “much improved function” (postoperative OHS ≥ 38.5 vs 42.5). Tercile-specific thresholds did not improve accuracy of thresholds (Cohens kappa 42%).</div></div><div><h3>Conclusions</h3><div>The present study demonstrates that patients with more severe preoperative symptoms require greater change scores to achieve clinically relevant improvements than patients with less severe preoperative symptoms. This study suggests that current one-size-fits-all thresholds for success of THA should be replaced with more nuanced thresholds.</div></div><div><h3>Level of evidence</h3><div>Level III, Therapeutic Study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101649"},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}