Watabe Takaya, Sengoku Takuya, Muramatsu Ryota, Kubota Masafumi, Sakurai Goro, Yoshida Shinya, Taniguchi Yuta
Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Ishikawa, 920- 8641, Kanazawa, Japan.
Institute of Science & Engineering, Kanazawa University, Kakuma-Machi, Kanazawa, Ishikawa, 920- 1192, Japan.
BMC Geriatr. 2025 Jul 2;25(1):476. doi: 10.1186/s12877-025-06135-w.
The patient characteristics and preoperative factors that affect the Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (QOL) after total knee arthroplasty (TKA) remain unclear. Therefore, we aimed to determine patient characteristics and preoperative risk factors associated with the lack of the minimal clinically important difference (MCID) in the KOOS QOL subscales 1 year after TKA.
This single-center cohort study included 149 patients with knee osteoarthritis who underwent primary TKA using the subvastus approach. Patients were divided into two groups based on whether they achieved or failed to achieve the 1-year postoperative MCID in KOOS, in reference to the preoperative baseline score.
Fifty-four patients did not achieve the MCID in the KOOS QOL scales 1 year after TKA. Significant predictors included in univariate analysis included the preoperative prevalence period, knee flexion range of motion (ROM), and KOOS pain, activities of daily living (ADL), and function in sports and recreation (Sport/Rec). Multivariate logistic regression analysis identified knee flexion ROM as the most significant factor (odds ratio: 1.080; 95% confidence interval: 1.048–1.112; = 0.001). According to the receiver operating characteristic curve, a preoperative knee flexion ROM of 120° was the threshold for predicting achieved MCID in the KOOS QOL 1 year postoperatively (sensitivity: 0.61; specificity: 0.86); the area under the curve was 0.81.
Patients with longer preoperative prevalence periods and higher preoperative KOOS pain, ADL, and Sport/Rec scores were more likely not to achieve the MCID in the QOL. Furthermore, limited preoperative knee flexion ROM may affect the risk of not achieving the MCID.
全膝关节置换术（TKA）后影响膝关节损伤和骨关节炎疗效评分（KOOS）生活质量（QOL）的患者特征和术前因素仍不清楚。因此，我们旨在确定与TKA术后1年KOOS QOL子量表中未达到最小临床重要差异（MCID）相关的患者特征和术前危险因素。
这项单中心队列研究纳入了149例采用股直肌下入路进行初次TKA的膝骨关节炎患者。根据术后1年是否达到KOOS的MCID，参照术前基线评分，将患者分为两组。
54例患者在TKA术后1年未达到KOOS QOL量表中的MCID。单因素分析中的显著预测因素包括术前患病时间、膝关节屈曲活动范围（ROM）以及KOOS疼痛、日常生活活动（ADL）和运动与娱乐功能（Sport/Rec）。多因素逻辑回归分析确定膝关节屈曲ROM是最显著的因素（比值比：1.080；95%置信区间：1.048–1.112；P = 0.001）。根据受试者工作特征曲线，术前膝关节屈曲ROM为120°是预测术后1年KOOS QOL中达到MCID的阈值（敏感性：0.61；特异性：0.86）；曲线下面积为0.81。
术前患病时间较长以及术前KOOS疼痛、ADL和Sport/Rec评分较高的患者更有可能在生活质量方面未达到MCID。此外，术前膝关节屈曲ROM受限可能会影响未达到MCID的风险。
