BACKGROUND Patients who undergo a second THA at least 1 year after the first one may experience different recovery courses after each THA. It is unknown what the clinically relevant improvements and healthcare utilization are after each THA in patients undergoing contralateral THA > 1 year apart. QUESTIONS/PURPOSES (1) Do patient-reported outcome measures (PROMs) differ at baseline and 1 year after THA for the first and second hip arthroplasty? (2) Does the likelihood of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds differ for the first and second hip arthroplasty? (3) Does utilization of healthcare within 90 days of THA, using discharge disposition, length of stay (LOS), and 90-day readmission risk as proxies, differ between the first and second hip arthroplasty? METHODS Between January 2016 and December 2021, a total of 14,023 primary THAs for hip osteoarthritis were performed at a large tertiary academic center, and data from each were longitudinally maintained in an institutional database. In this retrospective study, we excluded nonelective (n = 265), simultaneous bilateral (n = 89), staged bilateral < 1 year apart (n = 1856), unilateral THAs (n = 7541), and those who were lost prior to the minimum study follow-up of 1 year or had incomplete data sets (n =3618), leaving 654 contralateral THAs > 1 year apart (327 patients) for analysis here. The median (range) patient age was 64 years (26 to 88) at the time of the first THA and 66 years (27 to 88) at the second THA. The mean (IQR) time from first THA to second THA was 696 days (488 to 1008). In all, 62% (204 of 327) of patients were women, and 89% (286 of 321) were White. The median (range) BMI was 29 kg/m2 (first THA 16 to 60, second THA 18 to 56) at both THAs. PROMs were obtained preoperatively and at 1 year after each of the THAs and included Hip Disability and Osteoarthritis Outcome Score pain (HOOS-pain), physical function (HOOS-PS), and joint replacement (HOOS-JR) scores, as well as the Veterans Rand 12-Item Health Survey mental component summary score. Each was scored from 0 to 100, with higher scores representing better patient perceived outcomes. A distribution-based method was used to calculate the MCID thresholds (HOOS-pain 8.35, HOOS-PS 9.47, and HOOS-JR 7.76), while an anchor-based method was utilized for the PASS thresholds (HOOS-pain 80.6, HOOS-PS 83.6, and HOOS-JR 83.6). Healthcare utilization outcomes included discharge disposition, LOS, and 90-day readmission rates. RESULTS Patients had slightly lower baseline PROM scores in all HOOS subdomains before the first THA compared with the second THA (median HOOS-pain 38 versus 42, p < 0.001; HOOS-PS 54 versus 58, p < 0.001; HOOS-JR 43 versus 47, p < 0.001). The difference between baseline and 1-year postoperative scores was slightly larger in all HOOS subdomains after the first THA (median HOOS-pain difference 52 versus 50, p < 0.001; HOOS-PS difference 38 versus 31, p < 0.001; HOOS-JR difference 42 versus 39, p < 0.001). There was no difference in the percentage of patients achieving the MCID in HOOS-pain (97% versus 97%; p = 0.93), HOOS-PS (92% versus 88%; p = 0.17), and HOOS-JR (96% versus 94%; p = 0.18) between the first and second THAs. Although there was also no difference in the percentage of patients achieving PASS thresholds in HOOS-pain (81% versus 77%; p = 0.11), HOOS-PS (82% versus 79%; p = 0.055), and HOOS-JR (71% versus 71%; p = 0.39) between the first and second THAs, considerably fewer patients were reaching the PASS threshold in both THAs. After the second THA, slightly more patients were discharged home (95% versus 91%; p = 0.03) and had a very slightly shorter LOS (1.28 versus 1.35 days; p < 0.001). There was no difference in 90-day readmission rates between the first and second THA (4% versus 5%; p = 0.84). CONCLUSION In patients undergoing contralateral THA > 1 year apart, baseline PROMs were slightly worse before the first THA, and improvements were slightly greater compared with the second THA, although these differences were likely not clinically significant. Clinically meaningful improvements, based on MCID and PASS thresholds, were similar at 1 year for both THAs, yet 20% to 25% of patients reported inadequate pain relief after both surgeries. Healthcare utilization was also comparable between both procedures. Surgeons can use these findings to counsel patients on the likely similar outcomes following both their THAs. Future studies should explore factors contributing to inadequate pain relief and identify strategies to improve patient outcomes after both THAs.Level of Evidence Level III, therapeutic study.

中文翻译：

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对侧 THA 间隔超过 1 年：每次手术后 PROM 和医疗保健利用是否不同？


背景 在第一次 THA 后至少 1 年接受第二次 THA 的患者在每次 THA 后可能会经历不同的恢复过程。目前尚不清楚间隔 1 年接受对侧 THA > 的患者在每次 THA 后临床相关的改善和医疗保健利用率如何。问题/目的 （1） 第一次和第二次髋关节置换术在基线和 THA 后 1 年的患者报告结果测量 （PROM） 是否不同？（2） 第一和第二髋关节置换术达到最小临床重要差异 （MCID） 和患者可接受症状状态 （PASS） 阈值的可能性是否不同？（3） 第一次和第二次髋关节置换术在 THA 后 90 天内利用医疗保健，使用出院处置、住院时间 （LOS） 和 90 天再入院风险作为代理，是否不同？方法 2016 年 1 月至 2021 年 12 月期间，在一个大型高等教育中心共进行了 14,023 例髋骨关节炎原发性 SEA，每个 THA 的数据都纵向保存在机构数据库中。在这项回顾性研究中，我们排除了非选择性 （n = 265）、同时双侧 （n = 89）、相隔 1 年的分期双侧 < （n = 1856）、单侧 THA （n = 7541） 以及那些在最短研究随访 1 年之前丢失或数据集不完整 （n =3618） 的患者，留下 654 个相隔 1 年的对侧 THA > （327 名患者） 供分析。第一次 THA 时患者的中位 （范围） 患者年龄为 64 岁 （26 至 88 岁），第二次 THA 时为 66 岁 （27 至 88 岁）。从第一次 THA 到第二次 THA 的平均 （IQR） 时间为 696 天 （488 至 1008）。总共 62%（327 例中的 204 例）患者是女性，89%（321 例中的 286 例）是白人。 两个 THA 的中位（范围）BMI 均为 29 kg/m2（第一次 THA 16 至 60，第二次 THA 18 至 56）。PROM 在术前和每个 THA 后 1 年获得，包括髋关节残疾和骨关节炎结果评分疼痛 （HOOS-pain）、身体功能 （HOOS-PS） 和关节置换 （HOOS-JR） 评分，以及退伍军人兰德 12 项健康调查心理成分总结评分。每个评分从 0 到 100，分数越高代表患者感知的结果越好。使用基于分布的方法计算 MCID 阈值 （HOOS-pain 8.35 、 HOOS-PS 9.47 和 HOOS-JR 7.76），而基于锚的方法用于 PASS 阈值 （HOOS-pain 80.6 、 HOOS-PS 83.6 和 HOOS-JR 83.6）。医疗保健利用结果包括出院处置、LOS 和 90 天再入院率。结果 与第二次 THA 相比，患者在第一次 THA 之前所有 HOOS 子域的基线 PROM 评分略低（中位 HOOS 疼痛 38 对 42，p < 0.001;HOOS-PS 54 对 58，p < 0.001;HOOS-JR 43 对 47，p < 0.001）。第一次 THA 后，所有 HOOS 子域的基线评分和 1 年术后评分之间的差异略大（中位 HOOS 疼痛差异 52 vs 50，p < 0.001;HOOS-PS 差异 38 vs 31，p < 0.001;HOOS-JR 差异 42 对 39，p < 0.001）。在第一次和第二次 THA 之间，HOOS-pain （97% vs 97%;p = 0.93）、HOOS-PS （92% vs 88%;p = 0.17） 和 HOOS-JR （96% vs 94%;p = 0.18） 达到 MCID 的患者百分比没有差异。尽管在 HOOS-pain （81% vs 77%;p = 0.11）、HOOS-PS （82% vs 79%;p = 0.055） 和 HOOS-JR （71% vs 71%;p = 0.39） 在第一次和第二次 THA 之间，两个 THA 中达到 PASS 阈值的患者都少得多。第二次 THA 后，回家出院的患者略多 （95% 对 91%;p = 0.03），LOS 略短 （1.28 天 vs 1.35 天;p < 0.001）。第一次和第二次 THA 之间的 90 天再入院率没有差异 （4% vs 5%;p = 0.84）。结论 在间隔 1 年接受对侧 THA > 的患者中，基线 PROM 在第一次 THA 之前略差，与第二次 THA 相比改善略大，尽管这些差异可能没有临床意义。基于 MCID 和 PASS 阈值，两种 THA 在 1 年时具有临床意义的改善相似，但 20% 至 25% 的患者报告在两次手术后疼痛缓解不足。两种程序之间的医疗保健利用率也相当。外科医生可以利用这些发现来就两次 THA 后可能出现的相似结果向患者提供咨询。未来的研究应探讨导致疼痛缓解不足的因素，并确定在两项 THAs.证据水平 III 级治疗研究后改善患者预后的策略。