Defining Patient Acceptable Symptom State for Primary Total Hip Arthroplasty: A 10-Year Follow-Up Study
Author(s):Quesada-Jimenez R, Walsh EG, Schab AR, Cohen MF, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1016/j.arth.2025.08.016
Background
Statistical improvement in patient-reported outcomes (PROs) after total hip arthroplasty (THA) does not necessarily reflect whether patients achieve a satisfactory long-term functional state. This study aimed to define 10-year patient acceptable symptom state (PASS) thresholds for commonly used hip outcome measures following primary THA.
Methods
This Level 3 retrospective study used prospectively collected data from patients undergoing primary THA between 2008 and 2015 with 10-year follow-up. PASS thresholds were calculated using an anchor-based method for mHHS, HHS, HOOS-JR, and FJS. Receiver operating characteristic analysis was used to determine discriminative ability.
Key Findings
- 176 hips included at 10-year follow-up
- PASS thresholds defined as:
- mHHS: 79.5
- HHS: 81.3
- HOOS-JR: 75.1
- FJS: 76.0
- All PROs demonstrated acceptable to excellent discrimination (AUC 0.71–0.87)
- FJS showed the lowest but still acceptable AUC performance
Conclusion
This study establishes validated 10-year PASS thresholds for key THA outcome measures, providing durable benchmarks for defining long-term clinical success beyond statistical improvement.
What Does This Mean for Providers?
These thresholds help distinguish between patients who are merely improved versus those who are truly satisfied at long-term follow-up. They provide practical benchmarks for counseling, research interpretation, and defining success after THA at 10 years.