背景：为了深入了解全髋关节（THA）和全膝关节置换术（TKA）后患者报告的预后指标（PROM）评分的临床相关改善可能被低估或高估，我们比较了PROM应答者和非应答者的不良事件发生率,并评估了不良事件发生是否与无不良事件者的临床相关PROM改善相关.
方法：纳入了2017年1月至2019年12月在19家荷兰医院进行的所有主要THA和TKA。髋关节残疾和骨关节炎结果评分-身体功能简表（HOOS-PS）和膝关节损伤和骨关节炎结果评分-身体功能简表（KOOS-PS）用于评估THA和TKA后的身体功能，分别。不良事件包括1年的修订，重新接纳30天,30天并发症,和长(即，>第75百分位数）住院时间（LOS）。临床相关的改善被定义为HOOS-PS评分降低至少10分和KOOS-PS评分降低9分。不良事件与临床相关的HOOS-PS和KOOS-PS改善之间的关联使用针对患者特征和医院内患者聚类进行调整的二元逻辑回归模型进行评估。
结果：包括20,338THA和18,082TKA手术。不良事件通常在HOOS-PS和KOOS-PS非受访者中发生的频率高于受访者。THA患者正在经历翻修，并发症,或长LOS不太可能经历临床相关的HOOS-PS改善(比值比为0.11[0.06至0.20]，0.44[0.30至0.63]，和0.66[0.50至0.88]，分别)。TKA患者出现翻修或长LOS的患者不太可能出现临床相关的KOOS-PS改善（比值比为0.26[0.12to0.55]和0.63[0.50to0.80]，分别)。
结论：临床相关的HOOS-PS和KOOS-PS改善可能被高估，因为非受访者的不良事件发生率较高,而达到临床相关HOOS-PS和KOOS-PS改善的可能性较低.
BACKGROUND: The purpose of the study was to gain insight into how clinically relevant improvement in patient-reported outcome measure scores after total hip arthroplasty (THA) and total knee arthroplasty (TKA) may be underestimated or overestimated, we compared patient-reported outcome measure respondents and nonrespondents on their adverse event rates and assessed whether adverse event occurrence was associated with clinically relevant patient-reported outcome measure improvement from those without adverse events.
METHODS: All primary THAs and TKAs performed in 19 Dutch hospitals between January 2017 and December 2019 were included. The hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS) and knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS) were used to assess the physical function after THA and TKA, respectively. Adverse events included 1-year revision, 30-day readmission, 30-day complications, and long (ie, >75th percentile) length of stay. A clinically relevant improvement was defined as at least a 10-point decrease in HOOS-PS and 9 points in KOOS-PS scores. Associations between adverse events and clinically relevant HOOS-PS and KOOS-PS improvement were assessed using binary logistic regression models adjusted for patient characteristics and clustering of patients within hospitals.
RESULTS: There were 20,338 THA and 18,082 TKA procedures included. Adverse events occurred more frequently in HOOS-PS and KOOS-PS nonrespondents than in respondents. The THA patients experiencing revision, complications, or long length of stay were less likely to experience clinically relevant HOOS-PS improvements (odds ratios of 0.11 [0.06 to 0.20], 0.44 [0.30 to 0.63], and 0.66 [0.50 to 0.88], respectively). The TKA patients experiencing revision or long length of stay were less likely to experience clinically relevant KOOS-PS improvements (odds ratios of 0.26 [0.12 to 0.55] and 0.63 [0.50 to 0.80], respectively).
CONCLUSIONS: Clinically relevant HOOS-PS and KOOS-PS improvements are likely overestimated, as nonrespondents had higher adverse event rates which were associated with lower likelihood to achieve clinically relevant HOOS-PS and KOOS-PS improvements.
