JOA - 2026-06-17 - Journal Article
Obesity and Chronic Opioids Were Not Negatively Associated with Achieving Centers for Medicare and Medicaid Services Mandated Thresholds for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement Scores After Primary Total Hip Arthroplasty.
Buller LT, Luo TD, Deckard ER, Meding JB, Meneghini RM
Topics
Key Takeaway
76.8% of primary THA patients met the CMS-mandated 22-point HOOS JR SCB threshold at mean 22 months, and neither obesity nor chronic opioid use predicted failure to meet this benchmark.
Summary Depth
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Summary
This study evaluated predictors of achieving CMS-mandated HOOS JR improvement thresholds (SCB=22 points, MCID=6 points) in 1,682 consecutive primary THAs from a single-surgeon statewide healthcare system. On multivariable analysis, increasing BMI was the only variable associated with greater HOOS JR improvement (P=0.006), while chronic opioid use showed no association with threshold achievement (P≥0.336, power≥91.6%). 94.5% met the MCID of 6 points and 76.8% met the SCB of 22 points, with a mean improvement of 36.0 points.
Key Limitation
Single-surgeon retrospective design introduces selection bias, as a high-volume experienced surgeon's outcomes may not reflect the population of surgeons whose CMS reporting will be most consequential.
Original Abstract
BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) will begin mandating Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) improvement thresholds for total hip arthroplasty (THA) starting in 2026 and have established a 22-point improvement target. Surgeon and institutional data will be publicly reported, and some may avoid patients who have risk factors for poor outcomes such as chronic opioid use. The purpose of this study was to identify predictors of HOOS JR improvement based on the CMS-mandated HOOS JR improvement threshold.
METHODS
A total of 1,682 consecutive primary THAs were retrospectively reviewed. Patient data, including the presence of fibromyalgia, autoimmune disease, osteonecrosis, depression, chronic narcotic usage, and lumbar spine disease were manually extracted from a statewide healthcare system. Predictors of improvement in HOOS JR total scores were evaluated accounting for the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds established by CMS. Multivariable statistical analyses were performed with P < 0.05 indicating statistical significance.
RESULTS
At a mean clinical follow-up of 22 months, mean improvement in HOOS JR score from preoperative baseline was 36.0 points (range, -44 to 100). A total of 76.8% of patients met the HOOS JR SCB of 22 suggested by CMS, and 94.5% met the MCID threshold of 6.0. In multivariable analysis, only increasing body mass index was associated with greater improvement in HOOS JR scores (P = 0.006). Interestingly, chronic narcotic use was not associated with achieving HOOS JR thresholds or improvement scores (P ≥ 0.336, statistical power ≥ 91.6%).
CONCLUSION
In this single-surgeon retrospective cohort, obesity and preoperative chronic opioid use were not negatively associated with achievement of HOOS JR improvement score thresholds. Furthermore, with the variables collected in this study, very few patient characteristics demonstrated strong discriminatory ability for the CMS 22-point HOOS JR improvement threshold.