Guild George N, Bradham Anita Alex, Gresham Natalie, Schwab Joseph M, Alva Alexis, Bradbury Thomas L
Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, Cumming, GA, USA.
Arthroplast Today. 2025 Jun 24;34:101751. doi: 10.1016/j.artd.2025.101751. eCollection 2025 Aug.
Managed care systems have expressed interest in using patient-reported outcome measures (PROMs) to determine surgical eligibility for total knee arthroplasty (TKA). The relationship between PROMs and patient satisfaction following TKA is an area of active research. We asked (1) what is the relationship between patient satisfaction and achieving minimal clinically important difference (MCID) in Knee Injury Osteoarthritis Outcomes Survey for Joint Replacement (KOOS, JR) at 1 year post-TKA, (2) what is the optimal change in KOOS, JR from preoperative to 1-year post-TKA that predicts patient satisfaction, and (3) are there additional preoperative factors that influence patient satisfaction following TKA.
A retrospective cohort study analyzed patients who underwent primary TKA at a single ambulatory surgery center. Patients completed KOOS, JR and Veterans Rand 12-Item Health Survey (VR-12) at baseline, 12 weeks, 6 months, and 1 year postoperatively. Satisfaction was assessed using a Likert scale. Logistic regression, best-fit modeling, and classification and regression tree analyses were performed to determine predictors of satisfaction.
Among 600 patients, 93.7% were satisfied. MCID was met in 71.8% of satisfied patients vs 44.7% of unsatisfied patients ( < .001). Preoperative to 1-year change in KOOS, JR (odds ratio 1.09, < .001) and preoperative VR-12 mental component scores (odds ratio 1.05, = .007) predicted satisfaction. No change threshold for KOOS, JR predicted satisfaction.
While KOOS, JR improvement correlated with satisfaction, achieving MCID was not a reliable predictor. Preoperative factors, including VR-12 mental component scores, may better identify patients likely to be satisfied post-TKA. Further research on larger cohorts is needed to refine PROM-based eligibility criteria.
管理式医疗系统对使用患者报告的结局指标（PROMs）来确定全膝关节置换术（TKA）的手术资格表现出兴趣。TKA后PROMs与患者满意度之间的关系是一个活跃的研究领域。我们询问了：（1）TKA术后1年时，患者满意度与在膝关节损伤与骨关节炎关节置换结局调查（KOOS，JR）中达到最小临床重要差异（MCID）之间的关系是什么；（2）从术前到TKA术后1年，KOOS，JR的最佳变化是什么，该变化可预测患者满意度；（3）是否存在影响TKA术后患者满意度的其他术前因素。
一项回顾性队列研究分析了在单一门诊手术中心接受初次TKA的患者。患者在基线、术后12周、6个月和1年时完成KOOS，JR和退伍军人兰德12项健康调查（VR-12）。使用李克特量表评估满意度。进行逻辑回归、最佳拟合建模以及分类和回归树分析以确定满意度的预测因素。
在600例患者中，93.7%的患者表示满意。71.8%的满意患者达到了MCID，而不满意患者中这一比例为44.7%（P<0.001）。从术前到术后1年KOOS，JR的变化（优势比1.09，P<0.001）和术前VR-12心理成分得分（优势比1.05，P = 0.007）可预测满意度。KOOS，JR没有变化阈值可预测满意度。
虽然KOOS，JR的改善与满意度相关，但达到MCID并不是一个可靠的预测指标。包括VR-12心理成分得分在内的术前因素可能能更好地识别TKA术后可能满意的患者。需要对更大的队列进行进一步研究以完善基于PROM的资格标准。
