Time to MCID in Primary THA: Comparison of Anterior and Posterior Surgical Approaches

Mehdi S. Salimy, Aris Paschalidis, Jacquelyn Dunahoe, Antonia F. Chen, Kyle Alpaugh, Hany S. Bedair, Christopher M. Melnic
November 2023
Cite

Abstract

Introduction: There is much debate about differences in outcomes between anterior and posterior THA. This study aimed to compare the time to achieve the minimal clinically important difference (MCID) for the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-Physical for patients who underwent anterior and posterior surgical approaches in primary THA.

Methods: Patients from 2018 to 2021 with preoperative and postoperative HOOS-PS or PROMIS Global-Physical questionnaires were grouped by approach. Demographic and MCID achievement rates were compared, and survival curves with and without interval censoring were used to assess the time to achieve the MCID by approach. Logrank and weighted log-rank tests were used to compare groups, and Weibull regression analyses were performed to assess potential covariates.

Results: A total of 2,725 patients (1,054 anterior/1,671 posterior) were analyzed. Anterior THA patients had a lower BMI (28.0±5.6 vs. 28.6±5.8, p=0.05) and Charlson Comorbidity Index (6.1±2.8 vs. 6.6±3.1, p< 0.001) than posterior THA patients. There were no significant differences in median MCID achievement times for the HOOS-PS (anterior: 5.9 months, 95% CI: 4.6-6.4 months; posterior: 4.4 months, 95% CI: 4.1-5.1 months, p=0.65) or the PROMIS Global-Physical (anterior: 4.2 months, 95% CI: 3.5-5.3 months; posterior: 3.5 months, 95% CI: 3.4-3.8 months, p=0.08) between approaches. Interval censoring revealed earlier times of achieving the MCID for both the HOOS-PS (anterior: 1.509-1.511 months; posterior: 1.7-2.3 months, p=0.874) and the PROMIS Global-Physical (anterior: 3.0-3.1 weeks; posterior: 2.7-3.3 weeks, p=0.180) for both surgical approaches.

Conclusion: The time to achieve MCID did not differ by surgical approach. Most patients will achieve clinically meaningful improvements in physical function much earlier than previously believed. Choosing which surgical approach should be based on the patient’s specific condition and the surgeon’s expertise and preferences.

Type
Podium presentation
Publication
Presented at: American Association of Hip and Knee Surgeons Annual Meeting
total hip arthroplasty THA physical function minimal clinically important difference MCID PROM PROMIS approach anterior posterior time to event
Aris Paschalidis
Aris Paschalidis
Medical Student

My research interests include health analytics, infectious diseases, and artificial intelligence.

Related