Achievement Of Minimal Clinically Important Difference Research Articles

Effect of age and gender in rates of achieving minimal clinically important difference and patient-acceptable symptom state 2 years after arthroscopic superior capsular reconstruction.

This study aimed to evaluate patient-reported outcome measures (PROMs) and the effects of gender and age on achieving clinically significant outcomes in patients undergoing arthroscopic superior capsular reconstruction (ASCR) with a minimum 2-year follow-up. Patients undergoing ASCR for irreparable rotator cuff tear between 2013 and 2020 were reviewed. Preoperative and minimum 2-year postoperative PROMs were collected, including American Shoulder and Elbow Surgeons (ASES), Constant, single assessment numeric evaluation (SANE),and visual analog scale (VAS) scores. Minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were calculated for each functional score and analyzed according to age and gender. The percentages of patients achieving MCID and PASS were recorded. The study included 83 patients, with a mean follow-up of 3.5 ± 1.4 years. Significant improvements were found in ASES, Constant, SANE,and VAS for all groups based on gender and age. Based on receiver-operating characteristic curves, all scores had acceptable areas under the curve for PASS. Values for PASS and MCID were 81.5 and 10.3 for ASES; 61.5 and 6.2 for Constant; 82.5 and 11.5 for SANEand 1.5 and 1.1 for VAS, respectively. Analysis of achieving MCID and PASS showed no difference between the groups in the majority of outcome measures. However, female patients achieved the SANE thresholds for PASS at significantly higher rates than male patients. Patients ≥65 years old achieved ASES and Constant thresholds for MCID at significantly higher rates than patients ˂65 years old. Most patients achieved MCID and PASS at a 2-year follow-up. Patients showed comparable rates of MCID and PASS achievement on most outcome tools based on age and gender. Female patients achieved PASS on SANE at significantly higher rates than male patients and older patients achieved MCID on ASES and Constant at higher rates than young patients. Thus, age is a stronger factor for achieving MCID than gender. Level II.

Hip Gluteus Repair Yields Satisfactory Clinically Significant Outcome Achievement By 1 Year in a Majority of Patients: Those With Partial-Thickness Tears and Preoperative Hip Abduction Weakness Show Delayed Recovery

PurposeThe purposes of this study were (1) to define the time to achievement of clinically significant outcomes (CSOs) following primary gluteus medius and/or minimus (GM) repair and (2) to identify factors associated with delayed CSO achievement. MethodsPatients who underwent primary GM repair between January 2012 and June 2021 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score – Activities of Daily Living (HOS-ADL) were retrospectively identified. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated. The time to achievement of MCID and PASS were analyzed using Kaplan-Meier survival analysis. Median time to MCID and PASS achievement were recorded. Multivariate stepwise cox regressions were used to identify factors associated with delayed CSO achievement. ResultsFifty GM repairs were identified (age 59.4 ± 9.7 years, BMI 27.9 ± 6.2 kg/m2, 94% female). Tears were Grade 1 in 39 cases, Grade 2 in 7 cases, and Grade 3 in 4 cases. Endoscopic repair was performed in 35 cases, and open repair was performed in 15 cases. Labral debridement and repair were each performed in 15 cases. Median time to CSO achievement was 5.7 months for MCID and 11.0 months for PASS. The 2-year cumulative probability of MCID and PASS achievement was 92.7% and 66.7%, respectively. Preoperative hip abduction weakness on physical exam was associated with delayed achievement of MCID (Hazard Ratio (HR) = 2.27, Confidence Interval (CI) 1.067 – 7.41, p = 0.039) and PASS (HR= 3.89, CI 1.341 - 11.283, p = 0.012). ConclusionsThis study demonstrated that in patients undergoing repair of primarily Grade 1 GM tears, most achieved MCID by 6 months and over half achieved PASS by 12 months. Preoperative hip abduction weakness on physical exam was associated with delayed CSO achievement. Level of EvidenceRetrospective Case Series, IV.

Patients With and Without Double Crush Syndrome Achieve Similar Rates of Clinical Improvement Following Carpal Tunnel Release.

The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies. Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID). Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group. At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.

Preoperative Oswestry Disability Index Should not be Utilized to Determine Surgical Eligibility for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease.

Retrospective cohort study. To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion. As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient-reported outcomes (PROMs) in reimbursement approvals for orthopedic procedures. The feasibility of this has not been investigated in spine surgery. We included all adult patients undergoing one to three-level primary lumbar fusion at a single urban tertiary academic center from 2014 to 2020. ODI was collected preoperatively and one year postoperatively. We implemented theoretical threshold cutoffs at increments of 10. MCID was set at 14.3. The percent of patients meeting MCID were determined among patients "approved" or "denied" at each threshold. At each threshold, the positive predictive value (PPV) for MCID attainment was calculated. A total 1368 patients were included and 62.4% (N=364) achieved MCID. As the ODI thresholds increased, a greater percent of patients in each group reached the MCID. At the lowest ODI threshold, 6.58% (N=90) of patients would be denied, rising to 20.2%, 39.5%, 58.4%, 79.9%, and 91.4% at ODI thresholds of 30, 40, 50, 60, and 70, respectively. The PPV increased from 0.072 among patients with ODI>20 to 0.919 at ODI>70. The number of patients denied a clinical improvement in the denied category per patient achieving the MCID increased at each threshold (ODI>20: 1.96; ODI>30: 2.40; ODI>40: 2.75; ODI>50: 3.03; ODI>60: 3.54; ODI>70: 3.75). Patients with poorer preoperative ODI are significantly more likely to achieve MCID following lumbar spine fusion at all ODI thresholds. Setting a preoperative ODI threshold for surgical eligibility will restrict access to patients who may benefit from spine fusion despite ODI>20 demonstrating the lowest predictive value for MCID achievement. 3.

Does Your Patient Need to Lose Weight? Weight Change Before and After Total Hip Arthroplasty Does Not Affect Health Care Utilization and Achievement of the Minimal Clinically Important Difference

BackgroundDespite the potential negative impact of preoperative obesity on total hip arthroplasty (THA) outcomes, the association between preoperative and postoperative weight change and outcomes is much less understood. Therefore, this study aimed to determine the impact of preoperative and postoperative weight change and preoperative body mass index (BMI) on health care utilization, satisfaction, and achievement of minimal clinically important difference (MCID) for Hip Disability and Osteoarthritis Outcome Score Physical Function Short-Form (HOOS PS) and HOOS Pain. MethodsPatients who underwent primary elective unilateral THA between January 2016 and December 2019 were included (N = 2,868). Multivariable logistic regression assessed the association between BMI and preoperative and postoperative weight change on outcomes while controlling for demographic characteristics. ResultsThere was no association between preoperative weight change and prolonged length of stay (> 3 days), 90-day readmission, nonhome discharge, patient dissatisfaction at 1 year, or achievement of HOOS Pain or HOOS PS MCID. Postoperative weight loss was an independent risk factor for patient dissatisfaction at 1 year but was not associated with achievement of either HOOS Pain or HOOS PS MCID at 1-year postoperative. Preoperative obesity classes I to III were independent risk factors for nonhome discharge. Nevertheless, preoperative obesity class I and class II were associated with an increased probability of reaching HOOS Pain MCID. Preoperative BMI was not associated with an increased risk of patient dissatisfaction. ConclusionsPreoperative weight change does not appear to influence health care utilization, satisfaction, or achievement of MCID in pain and function following THA. Postoperative weight loss may play a role as a risk factor for dissatisfaction following THA. Additionally, patients who had a higher baseline BMI may be more likely to see improvement in pain following THA. Therefore, when counseling obese patients for THA, surgeons must balance the risk of perioperative complications with the expectation of greater improvements in pain.

Preoperative patient factors that predict achieving the minimal clinically important difference following arthroscopic treatment of snapping scapula syndrome

The aim of this study was to define minimal clinically important difference (MCID) values for patient-reported outcomes (PROs) after arthroscopic treatment of snapping scapula syndrome (SSS) using a distribution-based method, and to identify demographic, clinical, and intraoperative factors significantly associated with the achievement of MCID. Patients who underwent arthroscopic treatment of SSS between October 2005 and September 2020 with a minimum of 2-year short-term postoperative follow-up were enrolled in this retrospective monocentric study. The MCID was calculated using a distribution-based approach for the following patient-reported outcomes (PROs): 12-Item Short Form Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Single Assessment Numeric Evaluation (SANE), and VAS pain "today" and "at worst." The association between achievement of the MCID and postoperative subjective satisfaction was investigated and factors associated with achievement of MCID were determined using bivariate analysis. Of a total of 190 patients assessed for eligibility, 77 patients (38.1±14.3 years; 36 females) were included. Within the study population, statistically significant improvements in postoperative SF-12 PCS (p<.001) and MCS (p<0.034), ASES (p<.001), QuickDASH (p<.001), SANE (p<.001), and VAS pain (p<.001) were observed at minimum 2-year follow-up. The calculated MCID threshold values based on the study population were 5.0 for SF-12 PCS, 5.8 for SF-12 MCS, 11.3 for the ASES score, -10.5 for the QuickDASH score, 14.7 for SANE, 1.5 for the VAS pain, and 1.7 for the VAS pain at worst. Reaching the MCID was strongly associated with postoperative satisfaction (rated on a scale of 1-10). Across the PROs, younger age, favorable preoperative response to injection, partial scapuloplasty or scapulectomy, no prior surgery, as well as pain and function at baseline were significantly associated with attaining MCID. Patients who underwent arthroscopic treatment for SSS experienced clinically significant improvements in functional scores, pain, and quality of life. This study demonstrated predictive roles for certain patient-specific factors and diagnostic variables for achieving MCID in PROs, which may help surgeons preoperatively assess preoperatively the probability of success and manage patient expectations.

Predictors of achieving minimal clinically important difference in functional status for elderly patients with degenerative lumbar spinal stenosis undergoing lumbar decompression and fusion surgery

ObjectiveTo identify the predictors for the achievement of minimal clinically important difference (MCID) in functional status among elderly patients with degenerative lumbar spinal stenosis (DLSS) undergoing lumbar decompression and fusion surgery.MethodsPatients who underwent lumbar surgery for DLSS and had a minimum of 1-year follow-up were included. The MCID achievement threshold for the Oswestry Disability Index (ODI) was set at 12.8. General patient information and the morphology of lumbar paraspinal muscles were evaluated using comparative analysis to identify influencing factors. Multiple regression models were employed to identify predictors associated with MCID achievement. A receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cut-off values for predicting functional recovery.ResultsA total of 126 patients (46 males, 80 females; mean age 73.0 ± 5.9 years) were included. The overall rate of MCID achievement was 74.6%. Patients who achieved MCID had significantly higher psoas major muscle attenuation (43.55 vs. 39.23, p < 0.001) and preoperative ODI (51.5 vs. 41.6, p < 0.001). Logistic regression showed that elevated psoas major muscle attenuation (p = 0.001) and high preoperative ODI scores (p = 0.001) were independent MCID predictors. The optimal cut-off values for predicting MCID achievement were found to be 40.46 Hounsfield Units for psoas major muscle attenuation and 48.14% for preoperative ODI.ConclusionPreoperative psoas major muscle attenuation and preoperative ODI were reliable predictors of achieving MCID in geriatric patients undergoing lumbar decompression and fusion surgery. These findings offer valuable insights for predicting surgical outcomes and guiding clinical decision-making in elderly patients.

The Promising 2-Year Performance of the Patient-Reported Outcomes Measurement Information System in Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. Purpose: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. Results: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P < .001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, –13.8 and 78%, respectively; PROMIS-PI, –4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = −0.836), HOS-SS (r = −0.767), and iHOT-12 (r = −0.719) scores and exhibited at least moderate correlations (r≥−0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r≥−0.586). Strong correlations were seen between the hip-specific PROM scores (r≥−0.745). Conclusion: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores.

Patients with Borderline Hip Dysplasia Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Demonstrate Lower Outcome Scores but Comparable Survivorship to Non-Dysplastic Controls: A Propensity-Matched Study with Minimum 10-Year Follow-up

Background: Patients with borderline hip dysplasia (BHD) have demonstrated similar outcomes following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared to equivalent patients without dysplasia at short- and mid-term follow-up. However, outcomes in these groups have not yet been compared at long-term follow-up. Objectives: To compare long-term clinical outcomes following primary hip arthroscopy for FAIS between patients with BHD and non-dysplastic matched controls. Methods: A retrospective review was conducted of patients who underwent primary hip arthroscopy for FAIS from January 2012 through February 2013. Patients with BHD, defined as a lateral center edge angle (LCEA) between 18° and 25°, were propensity matched in a 1:3 ratio by sex, age, and body mass index (BMI) to non-dysplastic controls. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes (PROs) were collected preoperatively and 10 years postoperatively, and achievement rates of Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptom State (PASS) were calculated. PRO measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scales (VAS) for Pain and Satisfaction. Gross survivorship was assessed using Kaplan-Meier curves. PROs, MCID and PASS achievement rates, and survivorship were compared between groups. Results: Twenty-eight patients with BHD (71.4% female; age: 30.8 ± 10.8 years, BMI: 24.2 ± 3.9 kg/m2) were matched to 84 controls (66.7% female, age: 34.4 ± 10.5 years, BMI: 24.9 ± 5.1 kg/m2; p ≥ 0.135). Mean follow-up was 10.3 ± 0.3 years. There were no significant differences between groups in any demographic characteristics, radiographic measurements, or intraoperative findings (p ≥ 0.096), except pre- and post-operative LCEA and Tönnis angle, which were lower and higher, respectively, among BHD patients (p &lt; 0.001). Both groups demonstrated significant improvement in all PROs between the preoperative and 10-year postoperative time points (p &lt; 0.001 for all). Preoperative, 10-year postoperative, and magnitude of change (delta) in PRO scores were similar between groups for all measures (p ≥ 0.072), except 10-year postoperative HOS-SS (BHD: 62.9 ± 31.9 vs. Controls: 80.1 ± 26.0, p = 0.030) and change in VAS Pain (BHD: -34.2 ± 27.2 vs. Controls: -48.5 ± 26.1, p = 0.047). Rates of MCID achievement were similar between groups for all PRO measures, but rates of PASS achievement were significantly lower among BHD patients for HOS-ADL (BHD: 39.1% vs. Controls: 77.4%, p = 0.002), HOS-SS (BHD: 45.5% vs. Controls: 84.7%, p = 0.001), and VAS Pain (BHD: 50.0% vs. Controls: 78.5%, p = 0.015). There was no difference in reoperation rate between groups (BHD: 14.3% vs. Controls: 17.9%, p = 0.778). Kaplan-Meier survival analysis demonstrated comparable gross survivorship at long-term follow-up (p = 0.645). Conclusions: Patients with BHD undergoing primary hip arthroscopy for FAIS demonstrated significantly lower sports-specific PRO scores than propensity-matched controls at 10-year follow-up, with a trend toward significantly worse scores for measures assessing activities of daily living, pain, and satisfaction. Rates of MCID achievement were similar between groups, but BHD patients demonstrated lower rates of PASS achievement for the majority of PRO measures. However, patients with BHD had similar long-term hip survivorship compared to controls, with no significant differences in rates of revision hip arthroscopy or conversion to total hip arthroplasty.

Outcomes of Isolated Endoscopic Gluteal Tendon Repair Compared With Concomitant Endoscopic Gluteal Tendon Repair and Arthroscopic Hip Labral Repair: A Propensity-Matched Analysis With Minimum 2-Year Follow-up.

Both gluteal and labral tears are common sources of hip pain, but no studies have evaluated how concomitant arthroscopic labral repair and correction of femoroacetabular impingement syndrome (FAIS) affect outcomes after endoscopic gluteus/minimus repair. (1) To compare patient-reported outcomes (PROs) and clinically significant outcomes achievements between patients who underwent endoscopic gluteus medius/minimus and arthroscopic hip labral repair with correction of FAIS versus endoscopic gluteus medius/minimus repair without labral repair and (2) to define threshold scores required to achieve the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool, and visual analog scale for pain in these patients. Cohort study; Level of evidence, 3. Patients who underwent primary endoscopic gluteus medius/minimus repair between 2012 and 2020 were identified. Those who underwent concomitant arthroscopic labral repair and correction of FAIS with femoroplasty or acetabuloplasty as indicated were propensity matched in a 1 to 1 ratio by sex, age, and body mass index to patients who underwent gluteus medius/minimus repair without labral repair. Patients who completed the study PROs were assessed preoperatively and at 2 years postoperatively. Threshold scores required to achieve the MCID and PASS thresholds were calculated. A total of 32 patients who underwent simultaneous gluteal and labral repair (G+L) were matched to 32 patients who underwent gluteal repair without labral repair (G); 75% of patients in the G cohort underwent labral debridement, while 25% in this cohort received no labral treatment. A significant difference was observed between groups in preoperative mHHS scores (G+L, 54.4 ± 12.9 vs G, 46.3 ± 14; P = .048) but no differences in any other PRO scores (P≥ .207). The MCID/PASS thresholds were as follows: Hip Outcome Score-Activities of Daily Living (11.14/83.82), Hip Outcome Score-Sports Specific (16.07/59.72), mHHS (11.47/70.95), 12-item international Hip Outcome Tool (13.73/45.49), and visual analog scale for pain (14.30/22). There were no significant differences in MCID or PASS achievement rates between the 2 groups (P≥ .108). Patients who underwent combined G+L demonstrated comparable PROs and clinically significant outcomes achievement rates to patients who underwent G, highlighting sustained successful outcomes for patients with gluteal tendon pathology and concomitant FAIS and labral tears.

Outcomes of Minimally Invasive Decompression Alone Versus Fusion for Predominant Back Pain

Background: Although a few recent studies showed good outcomes in back pain-predominant patients following decompression alone, none of the studies had a comparative fusion group. Purpose: We sought to compare outcomes of minimally invasive decompression alone versus fusion in patients with predominant back pain. Methods: This retrospective cohort study included patients who underwent minimally invasive decompression alone or fusion and had preoperative back pain &gt; leg pain. Outcome measures were (1) patient-reported outcome measures (PROMs), (2) minimal clinically important difference (MCID) achievement, (3) patient acceptable symptom state (PASS) achievement, and (4) global rating change (GRC). As a subgroup analysis, MCID, PASS, and GRC rates were also compared between the decompression and fusion groups for patients with preoperative back pain &lt; leg pain. Results: Of 510 patients included, there were statistically significant improvements in all PROMs in both groups at &lt;6 and &gt;6 months with no significant difference in the magnitude of improvement. The fusion group showed significantly higher MCID achievement rates for Visual Analog Scale (VAS) back at &lt;6 months (85% vs 70%) and Oswestry Disability Index (ODI) at &gt;6 months (67% vs 51%). Proportion of patients achieving PASS and feeling better after surgery based on response to GRC showed no difference between the groups. The subgroup analysis for decompression versus fusion in patients with preoperative back pain &lt; leg pain showed no differences in MCID, PASS, or GRC rates. Conclusions: This retrospective cohort study found that in patients with predominant back pain, minimally invasive decompression alone had significantly less MCID achievement rates in VAS back at &lt;6 months and ODI at &gt;6 months. However, it did lead to an overall significant improvement in PROMs, similar PASS achievement rates, and similar responses on the GRC scale.

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty.

As obesity becomes more prevalent, more patients are at risk of lower extremity osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to test (1) the association of preoperative weight change with health care utilization and (2) the association of pre- and postoperative weight changes with failure to achieve satisfaction and minimal clinically important difference (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and function (KOOS-PS) 1 year after TKA. Prospectively collected monocentric data on patients who underwent primary TKA were retrospectively reviewed. Multivariable logistic regression assessed the influence of BMI and weight change on outcomes while controlling for confounding variables. Outcomes included prolonged length of stay (LOS >3 days), nonhome discharge, 90-day readmission rate, satisfaction, and achievement of MCID for KOOS-Pain and KOOS-PS. Preoperative weight change had no impact on prolonged LOS (gain, p = 0.173; loss, p = 0.599). Preoperative weight loss was associated with increased risk of nonhome discharge (odds ratio [OR]: 1.47, p = 0.003). There was also increased risk of 90-day readmission with preoperative weight gain (OR: 1.27, p = 0.047) and decreased risk with weight loss (OR: 0.73, p = 0.033). There was increased risk of nonhome discharge with obesity class II (OR: 1.6, p = 0.016) and III (OR: 2.21, p < 0.001). Weight change was not associated with failure to achieve satisfaction, MCID in KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of failure to reach MCID in KOOS-Pain (OR: 0.43, p = 0.005) and KOOS-PS (OR: 0.7, p = 0.007). Overall, pre- and postoperative weight change has little impact on the achievement of satisfaction and clinically relevant differences in pain and function at 1 year. However, preoperative weight gain was associated with a higher risk of 90-day readmissions after TKA. Furthermore, patients categorized in Class III obesity were at increased risk of nonhome discharge but experienced a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results raise awareness of the dangers of using weight changes and BMI alone as a measure of TKA eligibility.

The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion.

Retrospective cohort study. (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. 3.

Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up

To compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years. A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve. Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P= .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P= .999), orconversion to THA (age ≥40: 13.2%, age <40: 3.8%, P= .161) were identified. On Kaplan-Meier analysis, no significant difference (P=.321) was demonstrated in overall gross survivorship between cohorts. Patients with age≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts. Level III, retrospective comparative prognostic trial.

Does Preoperative Back Pain Impact Patient-reported Outcomes in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis?

Retrospective review. To determine postoperative clinical outcomes in patients undergoing minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for isthmic spondylolisthesis (IS). Few studies have examined the postoperative clinical trajectory in patients undergoing MIS-TLIF specifically for IS. Patients were separated into two cohorts based on the previously defined Visual Analog Scale (VAS) back pain (BP) for severe pain: VAS-BP <7 and VAS-BP ≥7. Patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System-physical function (PF), 12-item Short Form (SF-12) Physical/Mental Component Score, Patient Health Questionnaire-9, VAS-BP, VAS leg pain, and Oswestry Disability Index were collected preoperatively and up to 2-year postoperatively. Minimum clinically important difference (MCID) was calculated through previously defined thresholds. A total of 160 patients were recorded, with 58 patients in the VAS-BP <7 cohort. The VAS-BP <7 cohort demonstrated significant improvement in all PROMs at one or more postoperative time points. The VAS-BP ≥7 demonstrated significant improvement at 3 or more postoperative time points in all PROMs except for SF-12 Mental Component Score. The VAS-BP <7 cohort reported significantly superior preoperative and postoperative PROMs in all domains, except for SF-12 Physical Component Score. The VAS-BP ≥7 cohort had higher MCID achievement rates at one or more time points in multiple PROMs. Patients undergoing MIS-TLIF for IS demonstrated significant postoperative improvement in PF, mental function, pain, and disability outcomes independent of preoperative severity of BP. Patients with lower preoperative BP demonstrated superior outcomes in PF, mental function, pain, and disability. However, patients with greater preoperative BP achieved higher rates of MCID in mental function, BP, and disability outcomes. Patients with greater severity of preoperative BP undergoing MIS-TLIF for IS may experience greater rates of clinically relevant improvement in mental function, BP, and disability outcomes.

Functional Outcome Scores and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients With Tönnis Grade 1 Versus Grade 0 Arthritis: A Propensity-Matched Study at Minimum 10-Year Follow-up

Background: Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. Purpose: To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. Results: A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P = .805; BMI, 26.1 ± 3.9, P = .117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P < .05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P = .066) in the Tönnis grade 1 cohort. No significant difference (P > .05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P = .021), Hip Outcome Score Sports-Specific subscale (P = .016), and modified Harris Hip Score (P = .026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P = .006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P = .04). Conclusion: Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery.

Clinically significant outcome thresholds and rates of achievement by shoulder arthroplasty type and preoperative diagnosis

BackgroundClinically significant outcome (CSO) benchmarks have been previously established for shoulder arthroplasty by assimilating preoperative diagnoses and arthroplasty types. The purpose of this study was to establish unique CSO thresholds and compare the time-to-achievement of these for reverse shoulder arthroplasty (RSA) for osteoarthritis (GHOA), RSA for rotator cuff arthropathy (RCA), and total shoulder arthroplasty (TSA) for GHOA. Materials & MethodsConsecutive patients who underwent elective RSA for GHOA, TSA for GHOA, or RSA for RCA between February 2015 and May 2020, with 2-year minimum follow-up, were retrospectively identified from a prospectively maintained single surgeon registry. The American Shoulder and Elbow Surgeons (ASES) score was administered preoperatively and postoperatively at 2-week, 6-week, 3-month, 6-month, 1-year, and 2-year timepoints. Satisfaction and subjective overall improvement anchor questionnaires were administered at the time of final follow-up. Distribution-based methods was used to calculate the Minimal Clinically Important Difference (MCID), and anchor-based methods were used to calculate the Substantial Clinical Benefit (SCB) and the Patient Acceptable Symptom State (PASS) for each patient group. Median time to achievement, individual incidence of achievement at each time point, and cumulative incidence of achievement calculated using Kaplan-Meier survival curve analysis with interval censoring were compared between groups for each CSO. Cox-regression analyses were also performed to determine which patient factors were significantly associated with early or delayed achievement of CSOs. ResultsThere were 471 patients eligible for study analysis: 276 RSA for GHOA, 107 TSA for GHOA, 88 RSA for RCA. The calculated MCID, SCB, and PASS scores differed for each group. There were no significant differences in median time to achievement of any CSO between groups. Log-rank testing revealed that cumulative achievements significantly differed between groups for MCID (P = 0.014) but not for SCB (P = 0.053) or PASS (P = 0.620). On cox regression analysis, TSA patients had earlier achievement of SCB, whereas TSA and RSA for GHOA patients had earlier achievement of MCID. At two-years, a significantly higher percentage of RSA for GHOA patients achieved MCID and SCB compared to RSA for RCA (MCID:100%, 95.5%, P = 0.003, SCB:94.6%, 86.4%, P = 0.036). ConclusionCalculated CSO thresholds differ according to preoperative diagnosis and shoulder arthroplasty type. Patients undergoing TSA and RSA for GHOA achieve CSOs earlier than RSA for RCA patients, and a significantly higher percentage of RSA for GHOA patients achieve CSOs by 2 years compared to RSA for RCA patients.

Radiographic predictors of reaching minimal clinically important difference following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis.

The present study aimed to (1) compare sagittal alignment between patients with degenerative lumbar spondylolisthesis (DLS) who reached or missed the minimal clinically important difference (MCID) for clinical outcomes following lumbar fusion surgery (LFS) and (2) identify radiographic predictors associated with MCID achievement in DLS patients. A total of 91 single-level DLS patients who underwent LFS and had a minimum of 1-year follow-up were enrolled in this study. The assessed radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), segmental lumbar lordosis (SLL), slip percentage, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis. Changes in radiographic parameters were determined by subtracting the preoperative value from the final follow-up measurement. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for both back and leg pain. MCID values were set at 10 points for ODI, 2.1 points for VAS back pain, and 2.8 points for VAS leg pain. Patients were assigned to the reached MCID (rMCID) and missed MCID (mMCID) groups based on the postoperative (post-op) recovery of clinical outcomes. At the last follow-up, 68.1% (62/91), 72.5% (66/91), and 76.9% (70/91) of patients reached MCID for ODI, VAS back pain, and VAS leg pain, respectively. Concerning ODI, the rMCID group exhibited higher post-op LL (47.93° vs. 42.95°, P = 0.044), higher post-op SLL (17.08° vs. 14.41°, P = 0.032), higher post-op SS (34.46° vs. 30.63°, P = 0.027), higher ∆LL (5.90° vs. 2.44°, P = 0.017), higher ∆SLL (4.63° vs. - 1.03°, P < 0.001), higher ∆SS (4.76° vs. 1.23°, P = 0.002), lower post-op PT/PI (36.95% vs. 42.01%, P = 0.049), lower ∆PT (- 3.71° vs. 1.05°, P < 0.001), lower ∆PT/PI (- 7.45% vs. 1.97%, P < 0.001), and lower ∆PI-LL (- 5.43° vs. - 3.71°, P = 0.011) than the mMCID group. Regarding VAS back pain, the rMCID group showed higher post-op SLL (17.06° vs. 14.05°, P = 0.021), higher post-op SS (34.34° vs. 30.33°, P = 0.027), higher ∆SLL (3.93° vs. - 0.09°, P < 0.001), and lower ∆PT (- 2.91° vs. - 0.30°, P = 0.039) than the mMCID group. For VAS leg pain, higher ∆SLL (3.55° vs. 0.41°, P = 0.003) was observed in the rMCID group than in the mMCID group. Multivariate logistic regression analysis revealed that higher ∆SLL, higher ∆SS, and higher post-op SS were independent predictors for the achievement of MCID in patients with DLS. DLS patients who reached MCID following LFS demonstrated improved post-op spinopelvic alignment. Higher ∆SLL, higher ∆SS, and higher post-op SS were the critical parameters associated with MCID achievement in patients with DLS.

Preoperative Motor Function Associated with Short-Term Gain of Health-Related Quality of Life after Surgery for Lumbar Degenerative Disease: A Pilot Prospective Cohort Study in Japan.

This study aimed to estimate the relationship between preoperative motor function and short-term recovery of health-related quality of life after lumbar surgery in patients with lumbar degenerative disease. This prospective cohort study involved 50 patients with lumbar degenerative disease at a general hospital in Japan. The primary outcome was the achievement of minimal clinically important difference (MCID) for EuroQOL 5 dimensions (EQ-5D) at discharge. Preoperative demographic, medication, surgical, and physical function data were collected. Logistic regression analysis was performed using the achievement of MCID for EQ-5D as the dependent variable and preoperative characteristics, including the Five Times Sit to Stand test (FTSTS), Oswestry Disability Index (ODI), and Self-rating Depression Scale (SDS), as the independent variables. The logistic regression analysis showed that Model 1 had a moderate predictive accuracy (Nagelkerke R2: 0.20; Hosmer-Lemeshow test: p = 0.19; predictive accuracy: 70.0%). Among the independent variables in the logistic regression model, the FTSTS was the only independent variable related to the achievement of MCID for EQ-5D at discharge (odds ratio: 0.03; 95% CI: 1.79 × 10-3, 0.18). Our results highlighted the importance of baseline motor function in the postoperative recovery of health-related quality of life in individuals with lumbar degenerative disease.

Achievement of One-Year MCID Varies with Preoperative Function of Patients Undergoing Total Hip Arthroplasty

AbstractThe minimum clinically important difference (MCID) of an orthopaedic outcome measure is commonly used to assess treatment success including for patients undergoing total hip arthroplasty (THA). Various patient factors may contribute to MCID values in patients undergoing THA. The purpose of this study was to calculate the 1-year MCID for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) based on patient factors and evaluate if there were any differences between each cohort's MCID.A patient-reported outcome measure (PROM) database was reviewed for patients undergoing THA from 2017 to 2018. Patients were included that underwent primary THA and completed baseline and 1-year follow-up for Patient-Reported Outcome Measurement Information System 10-item global health form (PROMIS10) and HOOS-JR surveys. MCID was calculated using the distribution method and an anchor-based method that used the PROMIS10 Physical Health item. Differences in MCID were assessed between patient cohorts stratified by preoperative characteristics.For the 523 patients that underwent THA, the average 1-year HOOS-JR MCID values were 33.9 ± 16.3 (men), 37.0 ± 13.9 (women), 38.1 ± 17.1 (diagnosis of mental health), and 35.0 ± 14.6 (no diagnosis). MCID values were not significantly different between groups according to sex (p = 0.186) or mental health status (p = 0.302). MCID value did not correlate with body mass index (β = –0.126). MCID achievement had a notable inverse relationship with preoperative HOOS-JR.This study demonstrated that preoperative function of patients undergoing THA affects the ability to achieve HOOS-JR 1-year MCID. Future investigation is necessary to clarify which patient factors may affect MCID.