# Mapping the importance of each individual element accounted by HOOS and VR-12 on 1-year patient satisfaction after primary total hip arthroplasty: a prospective institutional analysis

## TL;DR

This study identifies which specific questions from health outcome surveys best predict patient satisfaction one year after hip replacement surgery, with differences observed between males and females.

## Contribution

The study reveals sex-specific predictors of patient satisfaction after hip arthroplasty using HOOS and VR-12 survey elements.

## Key findings

- In males, difficulty sitting or running comfortably and mental health factors like feeling down or having energy predicted satisfaction.
- In females, only feeling calm and peaceful was a significant predictor of satisfaction.
- Mental health aspects were more influential in predicting satisfaction for females compared to males.

## Abstract

This study aimed to determine the significance of individual questions from the hip osteoarthritis outcome score (HOOS), HOOS Physical Function Shortform (PS), HOOS Joint Replacement (JR), and Veterans-Rand (VR)-12 mental composite score (MCS) in achieving a patient acceptable symptom state (PASS).

A retrospective study of a prospectively collected cohort of 8236 unilateral elective primary THAs was analyzed. Responses were collected for 18 HOOS questions (pain, PS, and JR) and 6 VR-12 questions used to calculate MCS preoperatively and 1-year postoperatively. PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models stratified by sex.

Sex-specific differences in PASS attainment were observed. In males, a poorer preoperative response in HOOS-PS assessing a patient’s difficulty to sit or run comfortably due to their hip was independently associated with reduced odds of achieving PASS at 1-year post-THA (odds ratio [OR] = 0.66 [95% confidence interval [CI] 0.52–0.83], P = 0.001, and OR = 0.83 [0.73–0.95], P = 0.01, respectively). Additionally, a more favorable preoperative response in the MCS metric of feeling down and blue (OR = 1.15 [95% CI 1.03–1.28], P = 0.01) was associated with increased PASS attainment, whereas a poorer preoperative response to having energy (OR = 0.86 [95% CI 0.76–0.97], P = 0.02) was associated with reduced PASS attainment. In females, only a poorer preoperative response in feeling calm and peaceful (OR = 0.87 [95% CI 0.78–0.96], P = 0.01) was associated with reduced odds of PASS attainment.

Individual questions of the HOOS and VR-12 MCS were identified as being independently associated with achieving patient satisfaction at one-year following THA. Notably, predictors of satisfaction differed by sex, with both physical function and mental health factors playing a larger role in males, while mental health alone was predictive in females. Understanding specific aspects that matter most to patients, such as mental health, allows healthcare providers to tailor their care to better meet patients' needs. This approach could involve counseling, stress management techniques, and interventions aimed at reducing feelings of depression and anxiety.

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