Jacob S Borgida, Perry Lim, Lara L Cohen, Nicholas Sauder, Thuan V Ly, Hany S Bedair, Christopher M Melnic
{"title":"股骨颈骨折后患者行全髋关节置换术的时间至最小临床重要差异：一项倾向评分匹配研究。","authors":"Jacob S Borgida, Perry Lim, Lara L Cohen, Nicholas Sauder, Thuan V Ly, Hany S Bedair, Christopher M Melnic","doi":"10.5435/JAAOS-D-24-01493","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Conversion total hip arthroplasty (cTHA) is commonly used for patients with persistent osteoarthritis or failed fixation following femoral neck fracture (FNF). There are limited data comparing patient-reported outcomes between patients undergoing cTHA after FNF and primary THA (pTHA) patients. This study aimed to compare the time to reach the minimal clinically important difference for improvement (MCID) for the Hip Disability and Osteoarthritis Outcomes Score-Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, and PROMIS Physical Function short form 10a (PF-10a).</p><p><strong>Methods: </strong>Patients undergoing cTHA for FNF between 2016 and 2022 were identified from an institutional database and propensity score matched 1:4 to pTHA patients by age, sex, body mass index, and Charlson Comorbidity Index. Demographic and MCID achievement rates were compared. To assess the time to achieve MCID, survival curves with and without interval censoring were used.</p><p><strong>Results: </strong>A total of 258 THAs (52 FNF cTHA and 206 pTHA) were analyzed. All FNFs were managed surgically. The rate of achieving MCID was similar between the FNF cTHA and pTHA cohorts for all three PROMs. For PROMIS PF-10a, FNF cTHA had a markedly longer median time to MCID at 9.8 months (95% confidence interval [CI], 6.5 to 12.1) compared with 4.2 months (95% CI, 3.3 to 6.0) for pTHA (P < 0.001). Interval censoring revealed that FNF cTHA achieved MCID for PROMIS PF-10a between 5.07 and 5.34 months, whereas pTHA achieved MCID between 1.37 and 1.37 months (P < 0.001).</p><p><strong>Conclusion: </strong>The time to achieve MCID was markedly slower for FNF cTHA patients compared with pTHA patients. This delay in achieving MCID should be factored into shared decision-making discussions to enhance preoperative expectation management and patient education. Future research is needed to identify modifiable factors that could improve recovery outcomes for FNF cTHA patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Time to Minimal Clinically Important Difference in Patients Undergoing Conversion Total Hip Arthroplasty After Femoral Neck Fracture: A Propensity Score Matched Study.\",\"authors\":\"Jacob S Borgida, Perry Lim, Lara L Cohen, Nicholas Sauder, Thuan V Ly, Hany S Bedair, Christopher M Melnic\",\"doi\":\"10.5435/JAAOS-D-24-01493\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Conversion total hip arthroplasty (cTHA) is commonly used for patients with persistent osteoarthritis or failed fixation following femoral neck fracture (FNF). There are limited data comparing patient-reported outcomes between patients undergoing cTHA after FNF and primary THA (pTHA) patients. This study aimed to compare the time to reach the minimal clinically important difference for improvement (MCID) for the Hip Disability and Osteoarthritis Outcomes Score-Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, and PROMIS Physical Function short form 10a (PF-10a).</p><p><strong>Methods: </strong>Patients undergoing cTHA for FNF between 2016 and 2022 were identified from an institutional database and propensity score matched 1:4 to pTHA patients by age, sex, body mass index, and Charlson Comorbidity Index. Demographic and MCID achievement rates were compared. To assess the time to achieve MCID, survival curves with and without interval censoring were used.</p><p><strong>Results: </strong>A total of 258 THAs (52 FNF cTHA and 206 pTHA) were analyzed. All FNFs were managed surgically. The rate of achieving MCID was similar between the FNF cTHA and pTHA cohorts for all three PROMs. For PROMIS PF-10a, FNF cTHA had a markedly longer median time to MCID at 9.8 months (95% confidence interval [CI], 6.5 to 12.1) compared with 4.2 months (95% CI, 3.3 to 6.0) for pTHA (P < 0.001). Interval censoring revealed that FNF cTHA achieved MCID for PROMIS PF-10a between 5.07 and 5.34 months, whereas pTHA achieved MCID between 1.37 and 1.37 months (P < 0.001).</p><p><strong>Conclusion: </strong>The time to achieve MCID was markedly slower for FNF cTHA patients compared with pTHA patients. This delay in achieving MCID should be factored into shared decision-making discussions to enhance preoperative expectation management and patient education. Future research is needed to identify modifiable factors that could improve recovery outcomes for FNF cTHA patients.</p>\",\"PeriodicalId\":51098,\"journal\":{\"name\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5435/JAAOS-D-24-01493\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-01493","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Time to Minimal Clinically Important Difference in Patients Undergoing Conversion Total Hip Arthroplasty After Femoral Neck Fracture: A Propensity Score Matched Study.
Background: Conversion total hip arthroplasty (cTHA) is commonly used for patients with persistent osteoarthritis or failed fixation following femoral neck fracture (FNF). There are limited data comparing patient-reported outcomes between patients undergoing cTHA after FNF and primary THA (pTHA) patients. This study aimed to compare the time to reach the minimal clinically important difference for improvement (MCID) for the Hip Disability and Osteoarthritis Outcomes Score-Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, and PROMIS Physical Function short form 10a (PF-10a).
Methods: Patients undergoing cTHA for FNF between 2016 and 2022 were identified from an institutional database and propensity score matched 1:4 to pTHA patients by age, sex, body mass index, and Charlson Comorbidity Index. Demographic and MCID achievement rates were compared. To assess the time to achieve MCID, survival curves with and without interval censoring were used.
Results: A total of 258 THAs (52 FNF cTHA and 206 pTHA) were analyzed. All FNFs were managed surgically. The rate of achieving MCID was similar between the FNF cTHA and pTHA cohorts for all three PROMs. For PROMIS PF-10a, FNF cTHA had a markedly longer median time to MCID at 9.8 months (95% confidence interval [CI], 6.5 to 12.1) compared with 4.2 months (95% CI, 3.3 to 6.0) for pTHA (P < 0.001). Interval censoring revealed that FNF cTHA achieved MCID for PROMIS PF-10a between 5.07 and 5.34 months, whereas pTHA achieved MCID between 1.37 and 1.37 months (P < 0.001).
Conclusion: The time to achieve MCID was markedly slower for FNF cTHA patients compared with pTHA patients. This delay in achieving MCID should be factored into shared decision-making discussions to enhance preoperative expectation management and patient education. Future research is needed to identify modifiable factors that could improve recovery outcomes for FNF cTHA patients.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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