Nyring Marc Randall Kristensen, Olsen Bo Sanderhoff, Amundsen Alexander, Rasmussen Jeppe Vejlgaard
Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark.
World J Orthop. 2024 Feb 18;15(2):156-162. doi: 10.5312/wjo.v15.i2.156.
The minimal clinically important difference (MCID) is defined as the smallest meaningful change in a health domain that a patient would identify as important. Thus, an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.
To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.
Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital, Denmark. The patients were evaluated preoperatively and 3 months, 6 months, 12 months, and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID. Based on previous literature, MCID for WOOS, OSS, and CMS were defined as 12.3, 4.3, and 12.8 respectively.
Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis. Mean age at the time of surgery was 66 years (range 49.0-79.0, SD: 8.3) and 65% were women. One patient was revised within the two years follow-up. The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points [95% confidence interval (95%CI): 39.7-53.3, < 0.005] for WOOS, 18.2 points (95%CI: 15.5-21.0, < 0.005) for OSS and 37.8 points (95%CI: 31.5-44.0, < 0.005) for CMS. Two years postoperatively, 41 patients (87%) had an improvement in WOOS that exceeded the MCID, 45 patients (94%) had an improvement in OSS that exceeded the MCID, and 42 patients (88%) had an improvement in CMS that exceeded the MCID.
Based on three shoulder-specific outcome measures we find that approximately 90% of patients has a clinically relevant improvement. This is a clear message when informing patients about their prognosis.
最小临床重要差异（MCID）被定义为患者认为重要的健康领域中最小的有意义变化。因此，超过MCID的改善可用于定义个体患者的成功治疗。
量化盂肱关节骨关节炎解剖型全肩关节置换术后的临床改善率。
2017年3月至2019年2月期间，丹麦赫勒夫和根措夫特医院使用Global Unite全肩关节平台置换术对患者进行治疗。术前以及术后3个月、6个月、12个月和24个月使用西安大略肩骨关节炎指数（WOOS）、牛津肩评分（OSS）和Constant-Murley评分（CMS）对患者进行评估。临床相关改善率定义为术后24个月改善超过MCID的患者比例。根据既往文献，WOOS、OSS和CMS的MCID分别定义为12.3、4.3和12.8。
49例行Global Unite全肩关节平台置换术的患者纳入最终分析。手术时的平均年龄为66岁（范围49.0 - 79.0，标准差：8.3），65%为女性。1例患者在两年随访期间进行了翻修手术。从术前评估到两年随访，WOOS的平均改善为46.1分[95%置信区间（95%CI）：39.7 - 53.3，P < 0.005]，OSS为18.2分（95%CI：15.5 - 21.0，P < 0.005），CMS为37.8分（95%CI：31.5 - 44.0，P < 0.005）。术后两年，41例患者（87%）的WOOS改善超过MCID，45例患者（94%）的OSS改善超过MCID，42例患者（88%）的CMS改善超过MCID。
基于三种肩部特异性结局指标，我们发现约90%的患者有临床相关改善。在告知患者预后时，这是一个明确的信息。
