Defining Failure in Primary Total Joint Arthroplasty: The Minimal Clinically Important Difference for Worsening Score

  • Tyler J. Humphrey
    Affiliations
    Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
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  • Akhil Katakam
    Affiliations
    Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA

    Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Christopher M. Melnic
    Affiliations
    Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA

    Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Hany S. Bedair
    Correspondence
    Address correspondence to: Hany S. Bedair, MD, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114.
    Affiliations
    Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA

    Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    Search for articles by this author
Published:December 24, 2021DOI:https://doi.org/10.1016/j.arth.2021.12.025

      Abstract

      Background

      We define the value of the Minimal Clinically Important Difference for Worsening (MCID-W) for Patient-Reported Outcomes Measurement Information System Physical Function short form 10-a (PROMIS-PF-10a) score for primary total joint arthroplasty (TJA) of the hip and knee and describe the risk factors for patients scoring worse than the MCID-W.

      Methods

      This retrospective study was performed using 3414 primary TJA patients. PROMIS-PF-10a scores were collected at the preoperatively and postoperatively, and patients were classified based on reaching Minimal Clinically Importance Difference for Improvement (MCID-I), MCID-W, or “no significant change” after TJA (scores betweex`n MCID-W and MCID-I). MCID-W and MCID-I values were determined by a distribution method. The association between numerous variables and scoring worse than the MCID-W of PROMIS-PF-10a was then evaluated through multiple logistic regression. A threshold for preoperative PROMIS-PF-10a score predicting decline past MCID-W was determined using the Youden index and receiver operating characteristic curve.

      Results

      The MCID-W for TJA was −1.89. Notably, increasing length of stay (odds ratio [OR] 1.073, 95% confidence interval [CI] 1.029-1.119, P < .001) and increasing preoperative PROMIS-PF-10a scores (OR 1.117, 95% CI 1.091-1.144, P < .001) were associated with increased likelihood of decline past the MCID-W of the PROMIS-PF-10a for TJA compared with patients who achieved the MCID-I. A community hospital with a dedicated joint replacement center was associated with a decreased risk for decline past the MCID-W (OR 0.601, 95% CI 0.402-0.899; P = .013).

      Conclusion

      We described the MCID-W value (−1.89) for the PROMIS-PF-10a questionnaire for knee and hip TJA and associated patient- and hospital-level risk factors for failure after TJA. Healthcare funding initiatives should be directed toward modifiable factors associated with clinically significant worse outcomes after TJA.

      Keywords

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