From the Department of Orthopaedics, Henry Ford Hospital, Detroit, MI.
J Am Acad Orthop Surg. 2021 Dec 15;29(24):e1417-e1426. doi: 10.5435/JAAOS-D-20-01288.
The patient-specific factors influencing postoperative improvement after total knee arthroplasty (TKA) are important considerations for the surgeon and patient. The primary purpose of this study was to determine which patient demographic factors influence the postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (GH) scores. In addition, we aimed to compare the prognostic utility of preoperative PROMIS-GH scores and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) in predicting postoperative improvement.
This retrospective cohort study of a consecutive series of patients who underwent primary, unilateral TKA analyzed prospectively collected KOOS-JR and PROMIS-GH surveys. PROMIS-GH includes physical health (PH) and mental health scores. Patient demographic and presurgical characteristics were evaluated for prognostic capability in predicting postoperative improvement in the PROMIS scores and achievement of the minimal clinically important difference (MCID). Receiver operating characteristic curves were used to understand the prognostic thresholds of the preoperative PROMIS score and KOOS-JR for predicting MCID achievement.
A total of 872 patients were included. Although unadjusted analyses showed associations between patient demographic factors and PROMIS-PH scores, multivariable regression analysis for predictors of MCID achievement demonstrated that PROMIS-PH was the only significant preoperative variable. Receiver operating characteristic analysis revealed that the area under the curve of PROMIS-PH (0.70; 95% CI, 0.67 to 0.74) was less than that of the KOOS-JR (0.77; 95% CI, 0.73 to 0.81; P = 0.032). Sensitivity and specificity for achieving the MCID were maximized for preoperative PROMIS-PH scores of ≤ 38 (59% and 70%) and for preoperative KOOS-JR ≤ 51 (71% and 69%).
Preoperative KOOS-JR and PROMIS-PH scores predict clinically meaningful improvement after TKA. The KOOS-JR has greater prognostic utility in the early postoperative period.
Level III, Prognostic Study.
影响全膝关节置换术（TKA）后术后改善的患者特定因素是外科医生和患者的重要考虑因素。本研究的主要目的是确定哪些患者人口统计学因素会影响术后患者报告的结局测量信息系统（PROMIS）总体健康（GH）评分。此外，我们旨在比较术前 PROMIS-GH 评分和膝关节损伤和骨关节炎结果评分-关节置换（KOOS-JR）在预测术后改善方面的预后能力。
这项连续系列患者的回顾性队列研究分析了前瞻性收集的 KOOS-JR 和 PROMIS-GH 调查。PROMIS-GH 包括身体健康（PH）和心理健康评分。评估患者人口统计学和术前特征在预测 PROMIS 评分的术后改善和达到最小临床重要差异（MCID）方面的预测能力。接收者操作特征曲线用于了解术前 PROMIS 评分和 KOOS-JR 预测 MCID 实现的预测阈值。
共纳入 872 例患者。尽管未调整分析显示患者人口统计学因素与 PROMIS-PH 评分之间存在关联，但多变量回归分析表明，达到 MCID 的预测因素表明 PROMIS-PH 是唯一显著的术前变量。接收者操作特征分析显示，PROMIS-PH 的曲线下面积（0.70；95%CI，0.67 至 0.74）小于 KOOS-JR（0.77；95%CI，0.73 至 0.81；P = 0.032）。实现 MCID 的最佳术前 PROMIS-PH 评分分别为≤38（59%和 70%）和术前 KOOS-JR≤51（71%和 69%）。
术前 KOOS-JR 和 PROMIS-PH 评分可预测 TKA 后的临床显著改善。KOOS-JR 在术后早期具有更大的预后能力。
三级，预后研究。
