The Journal of Arthroplasty, Volume 35, Issue 1, 145 - 152.e2

The Patient Acceptable Symptom State for the Harris Hip Score Following Total Hip Arthroplasty: Validated Thresholds at 3-Month, 1-, 3-, 5-, and 7-Year Follow-Up

Galea, Vincent P. et al.


The Patient Acceptable Symptom State (PASS) represents the value on a patient-reported outcome measure scale beyond which patients consider themselves well or in a satisfactory state. The aim of this study is to define and validate the PASS threshold for the HHS at 3 months, 1, 3, 5, and 7 years after THA.


A total of 976 patients from 14 centers in 7 countries were enrolled into a prospective study. Patients completed the HHS and a numerical rating scale for satisfaction at each follow-up. PASS thresholds for the HHS were calculated at each follow-up interval using the anchor-based, 80% specificity method. A bootstrapping method was used to internally validate the primary PASS thresholds. A patient sample sourced from an institutional registry was used for external validation.


The HHS was an excellent predictor of satisfaction at each time point (area under the curve > 0.8; P < .001). PASS thresholds for the HHS were 76 points at 3 months, 89 points at 1 year, 93 points at 3 years, 94 points at 5 years, and 93 points at 7 years. When applied to the internal and external validation cohorts, all PASS thresholds showed acceptable or excellent ability to predict satisfaction (area under the curve = 0.73-80; P < .001).


The present study is the first to present validated PASS thresholds for the HHS following THA. These findings will serve as a useful reference for future THA outcome studies and as benchmarks for surgeons in their assessment of their patients’ clinical success.

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