Patient-reported outcomes at 1 and 2 years after total hip and knee arthroplasty: what is the minimum required follow-up?



The purpose of this study was to test for differences between patient-reported outcome measures (PROMs) at 1 and 2 years following total hip (THA) or knee (TKA) arthroplasty.


Between 2015 and 2016, n = 469 and n = 414 patients underwent THA and TKA, respectively. Demographic and PROMs data were collected at 1 and 2 years post-operatively. PROMs included Veterans Rand 12-item (VR-12), Hip Injury and Osteoarthritis Outcomes Score (HOOS) Pain subscore, HOOS-Physical Function Short-form (HOOS-PS), Knee Injury and Osteoarthritis Outcomes Score (KOOS) Pain subscore, and KOOS-Physical Function Short-form (KOOS-PS). Paired t tests assessed differences between groups. N = 298 (65.8%) and n = 240 (64%) patients followed-up at 1 year, and 205 (72% of 1-year responders) and 174 (76%) at 2 years in the THA and TKA cohorts, respectively.


No statistically significant differences were observed between 1 and 2 years for HOOS pain (p = 0.445), HOOS-PS (p = 0.265), VR-12 PCS (p = 0.239), VR-12 MCS scores (p = 0.342) in THA and TKA cohorts [KOOS pain (p = 0.242), KOOS-PS (p = 0.088), VR-12 PCS (p < 0.2757), VR-12 MCS scores (p < 0.075)]. There were statistically significant baseline differences between responders and non-responders (patients lost to follow-up), but differences were small and not clinically relevant. PROMs were not significantly different between 1- and 2-year time points for THA and TKA. Minimal demographic or baseline differences between responders and non-responders suggest a representative sample.


These data support a minimum follow-up of 1 year for studies with PROMs as the primary outcome variable following THA and TKA.

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The Cleveland Clinic OME Arthroplasty Group consists of: Marcelo BP Siqueira, MDa; Peter A Surace, MDa; Wael K. Barsoum, MDa; Isaac Briskin, MAb; Carlos A Higuera Rueda, MDa; Atul F. Kamath, MDa; Alison K Klika, MSa; Melissa N Orr, BSa ; Brian M Leo, MDc; Preetesh D. Patel, MDa; Jordan Patterson, BSd; Kurt P Spindler, MDe; Amy Shuster, BSd; Gregory J Strnad, MSe; Juan Suarez, MDc, Robert Zaas, BAf; Nicolas S Piuzzi, MDa. aCleveland Clinic Department of Orthopaedic Surgery, 9500 Euclid Avenue, Cleveland, OH 44195, USA. bCleveland Clinic Department of Quantitative Health Sciences, 9620 Carnegie Avenue, Cleveland, OH 44106. cCleveland Clinic Florida, 2950 Cleveland Clinic Blvd. Weston, FL 33331, USA. dOhio University Heritage College of Osteopathic Medicine, 35 W Green Dr, Athens, OH 45701 USA. eCleveland Clinic Orthopaedic Sports Health, 5555 Transportation Blvd., Garfield Heights, OH 44125 USA. fCase Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106 USA. Thank you to the Cleveland Clinic orthopaedic patients, staff, and research personnel whose efforts related to regulatory, data collection, subject follow-up, data quality control, analyses, and manuscript preparation have made this consortium successful. Also thank you to Brittany Stojsavljevic, editor assistant, Cleveland Clinic Foundation, with editorial management.


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Correspondence to Nicolas S. Piuzzi M.D..

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Conflict of interest

Dr. Bogliolo Piancastelli Siqueira has nothing to disclose. Dr. Surace has nothing to disclose. Dr. Barsoum reports personal fees from DJO, personal fees from Stryker, personal fees from Zimmer, personal fees from Orthosensor, other from Custom Orthopaedic Solutions, other from PeerWell, other from Capsico Health, personal fees from Exactech, personal fees from Arthrex, other from Beyond Limits, other from Sight Medical, other from PT Genie, outside the submitted work. Mr. Briskin reports personal fees from CHEST Journal, outside the submitted work. Dr. Higuera reports grants from Stryker, grants and personal fees from KCI, grants from Ferring Pharmaceuticals, grants from CD Diagnostics, grants from OREF, grants from Orthofix, grants from Lyfstoine, grants from Zimmer Biomet, outside the submitted work. Dr. Kamath reports personal fees and other from DePuy Synthes, personal fees and other from Zimmer Biomet, outside the submitted work. Ms. Klika has nothing to disclose. Ms. Orr has nothing to disclose. Dr. Leo reports other from Zimmer Biomet, outside the submitted work. Dr. Patel reports personal fees from Stryker, personal fees from Zimmer-Biomet, outside the submitted work. Mr. Patterson has nothing to disclose. Dr. Spindler reports grants from NIH/NIAMS R01 AR053684, grants from NIH/NIAMS R01 AR074131, grants from NIH/NIAMS R01 AR075422-01, other from NFL, other from Service Excellence, other from Mitek, other from Flexion Therapeutics, other from Samumed, other from Novopeds, outside the submitted work. Ms. Shuster has nothing to disclose. Mr. Strnad has nothing to disclose. Dr. Suarez reports other from Corin USA, other from Depuy Orthopedics, outside the submitted work. Mr. Zaas has nothing to disclose. Dr. Piuzzi reports other from ISCT, other from Orthopaedic Research Society, other from Zimmer, outside the submitted work.

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This study was approved under Cleveland Clinic IRB #06-196.

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The members of Cleveland Clinic O. M. E. Arthroplasty Group are list in acknowledgements.

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Piuzzi, N.S., Cleveland Clinic O. M. E. Arthroplasty Group., Siqueira, M.B. et al. Patient-reported outcomes at 1 and 2 years after total hip and knee arthroplasty: what is the minimum required follow-up?. Arch Orthop Trauma Surg (2021).

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  • Total knee arthroplasty
  • Total hip arthroplasty
  • Patient-reported outcomes
  • Follow-up
  • Clinical outcomes study