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IF 1.6 4区医学 Q3 ORTHOPEDICS

Journal of Knee Surgery Pub Date : 2025-03-11 DOI:10.1055/a-2555-1941

Perry Lim, Marcos Gonzalez, Hany Bedair, Christopher M Melnic

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引用次数: 0

摘要

背景：在美国，对单间室膝关节置换术（UKA）的需求不断增加，因此患者的一年满意度很高。然而，一些患者在术后的患者报告结果指标（PROMs）出现大幅下降，我们称之为 "恶化的最小临床重要性差异"（MCID-W）。我们试图定义特定 PROMs 的 MCID-W 值，并确定与 UKA 术后 PROMIS 身体功能简表 10a （PROMIS PF-10a）下降相关的风险因素：我们对 2016 年至 2023 年期间在我院接受 UKA 的 760 名患者进行了回顾性研究。我们收集了术前和术后的 PROMIS PF-10a、PROMIS 整体体能以及膝关节损伤和骨关节炎结果评分-体能简表（KOOS-PS）得分。根据达到最小临床重要性改善差异（MCID-I）、MCID-W 或 "无显著变化"（得分介于 MCID-W 和 MCID-I 之间）对患者进行分层。MCID-W 和 MCID-I 值采用基于分布的方法确定。通过逻辑回归确定得分低于 MCID-W 的风险因素：我们确定了以下 MCID-I 和 MCID-W 临界值：结果：我们确定了以下 MCID-I 和 MCID-W 临界值：PROMIS PF-10a（+3.00 和-1.64）、KOOS-PS（+6.25 和-3.42）和 PROMIS Global-Physical（+2.72 和-1.55）。双变量分析显示，在翻修（P=0.02）、再次手术（P=0.03）、术后并发症（P=0.002）、深静脉血栓（DVT）（P35（几率比[OR]=2.49）、术后并发症（OR=5.09）、肺炎（OR=22.39）、深静脉血栓（OR=9.27）和术前PROMIS PF-10a评分（OR=1.07）是得分低于MCID-W阈值的风险因素，而年龄>80（OR=2.89）和术前PROMIS PF-10a评分（OR=1.05）是未能达到MCID-I的风险因素：结论：我们的研究确定了初治UKA术后关键PROMs的MCID-W值。我们发现，8.8% 的患者得分低于 MCID-W，这突出表明需要改进 UKA 的患者选择和围手术期护理。

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Risk Factors and Thresholds for Minimal Clinically Important Difference in Worsening after Unicompartmental Knee Arthroplasty.

Background: The rising demand for unicompartmental knee arthroplasty (UKA) in the United States has led to high one-year patient satisfaction rates. However, some patients experience substantial declines in patient-reported outcome measures (PROMs) post-operatively, which we refer to as "Minimal Clinically Importance Difference for Worsening " (MCID-W). We sought to define MCID-W values for specific PROMs and identify risk factors associated with PROMIS Physical Function Short Form 10a (PROMIS PF-10a) declines after UKA.

Methods: We conducted a retrospective study of 760 patients undergoing UKA at our institution between 2016 and 2023. Preoperative and postoperative PROMIS PF-10a, PROMIS Global Physical, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores were collected. Patients were stratified upon reaching Minimal Clinically Importance Difference for Improvement (MCID-I), MCID-W, or "no significant change" (score between MCID-W and MCID-I). MCID-W and MCID-I values were determined using a distribution-based method. Logistic regression was performed to identify risk factors for scoring below MCID-W.

Results: We established the following MCID-I and MCID-W thresholds: PROMIS PF-10a (+3.00 and -1.64), KOOS-PS (+6.25 and -3.42), and PROMIS Global-Physical (+2.72 and -1.55). Bivariate analysis revealed differences in terms revision (P=0.02), reoperation (P=0.03), postoperative complications (P=0.002), deep venous thrombosis (DVT) (P<.001), and pneumonia (P=0.01) between cohorts. Body mass index >35 (odds ratio [OR]=2.49), postoperative complications (OR=5.09), pneumonia (OR=22.39), DVT (OR=9.27), and pre-operative PROMIS PF-10a scores (OR=1.07) were risk factors for scoring below the MCID-W threshold, whereas age > 80 (OR=2.89) and pre-operative PROMIS PF-10a scores (OR=1.05) were risk factors for failing to achieve MCID-I.

Conclusion: Our study established MCID-W values for pivotal PROMs after primary UKAs. We found that 8.8% of patients scored below MCID-W, highlighting the need to improve patient selection and perioperative care in UKA.

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来源期刊

Journal of Knee Surgery ORTHOPEDICS-

CiteScore

4.50

自引率

5.90%

发文量

139

期刊介绍： The Journal of Knee Surgery covers a range of issues relating to the orthopaedic techniques of arthroscopy, arthroplasty, and reconstructive surgery of the knee joint. In addition to original peer-review articles, this periodical provides details on emerging surgical techniques, as well as reviews and special focus sections. Topics of interest include cruciate ligament repair and reconstruction, bone grafting, cartilage regeneration, and magnetic resonance imaging.