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Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Background

No previous study has evaluated the MCID for revision total knee arthroplasty (TKA). This study aimed to identify the MCID for the Knee Society Score (KSS), for revision TKA.

Methods

Prospectively collected data from 270 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively, at 6 months and 2 years using Knee Society Function Score (KSFS) and Knee (KSKS) Scores, and Oxford Knee Score (OKS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in OKS ≥ 5, patient satisfaction, and implant survivorship following revision TKA.

Results

The cohort comprised 70% females, with mean age of 69.0 years, that underwent unilateral revision TKA. The MCID determined by anchor-based linear regression method using OKS was 6.3 for KSFS, and 6.6 for KSKS. The MCID determined by anchor-based ROC was between 15 and 20 for KSFS (AUC: satisfaction = 71.8%, survivorship = 61.4%) and between 33 and 34 for KSKS (AUC: satisfaction = 76.3%, survivorship = 67.1%). The MCID determined by distribution-based method of 0.5 SD was 11.7 for KSFS and 11.9 for KSKS.

Conclusion

The MCID of 6.3 points for KSFS, and 6.6 points for KSKS, is a useful benchmark for future studies looking to compare revision against primary TKA outcomes. Clinically, the MCID between 15 and 20 for KSFS and between 33 and 34 for KSKS is a powerful tool for discriminating patients with successful outcomes after revision TKA. Implant survivorship is an objective and naturally dichotomous outcome measure that complements the subjective measure of patient satisfaction, which future MCID studies could consider utilizing as anchors in ROC.

Level of evidence

II.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore

    Yong Zhi Khow, Ming Han Lincoln Liow, Graham S. Goh, Jerry Yongqiang Chen, Ngai Nung Lo & Seng Jin Yeo

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  1. Yong Zhi Khow
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  2. Ming Han Lincoln Liow
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  3. Graham S. Goh
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  4. Jerry Yongqiang Chen
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  5. Ngai Nung Lo
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  6. Seng Jin Yeo
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Contributions

YZK (Medical Student): conceptualized the study, performed the methodology, validation, and statistical analysis, wrote, reviewed, and edited the manuscript. MHLL (Orthopaedic Surgeon): conceptualized and supervised the study, performed the methodology, wrote, reviewed, and edited the manuscript. GSG (Orthopaedic Surgeon): supervised the study, wrote, reviewed, and edited the manuscript. JYQC (Orthopaedic Surgeon): supervised the study, reviewed the manuscript. NNL (Orthopaedic Surgeon): supervised the study, reviewed the manuscript. SJY (Orthopaedic Surgeon): supervised the study, reviewed the manuscript.

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Correspondence to Ming Han Lincoln Liow.

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Ethical approval for this study was obtained from the SingHealth Centralized Institution Review Board (CIRB 2020/2237).

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Khow, Y.Z., Liow, M.H.L., Goh, G.S. et al. Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 2744–2752 (2022). https://doi.org/10.1007/s00167-021-06628-2

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