Skip to main content
SpringerLink
Log in

Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA).

Methods

A distribution-based method (one-half the standard deviation of the mean difference between postoperative and preoperative outcome scores) was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement.

Results

MDC thresholds for the Kujala score were 10.3 (71.1% achievement) and 10.6 (70.4% achievement) at one- and two years, respectively. The MDC thresholds for the IKDC score were 11.2 (78.1% achievement) and 12.3 (69.0% achievement) at one- and two years, respectively. Predictors of achieving the MDC for the Kujala and IKDC scores at both time points were lower preoperative Kujala and IKDC scores, respectively. Preoperative thresholds of ≤ 24.1 and 7.6 for the Kujala and IKDC scores, respectively, were associated with a 90% MDC achievement probability. When preoperative thresholds approached 64.3 and 48.3 for the Kujala and IKDC, respectively, MDC achievement probability reduced to 50%.

Conclusion

The MDC thresholds for the Kujala and IKDC scores two years after PFA were 10.6 and 12.3, respectively. Clinically significant health status changes were maintained overall, with a slight decrease in achievement rates between one and two years. MDC achievement was associated with disability at presentation, and several probability-based preoperative thresholds were defined. These findings may assist knee surgeons with patient selection and the decision to proceed with PFA by better understanding the patient-specific propensity for MDC achievement.

Level of evidence

IV, retrospective case series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

References

  1. Baker JF, Caborn DN, Schlierf TJ, Fain TB, Smith LS, Malkani AL (2020) Isolated patellofemoral joint arthroplasty: can preoperative bone scans predict survivorship? J Arthroplasty 35:57–60

    Article  PubMed  Google Scholar 

  2. Bernard CD, Pareek A, Sabbag CM, Parkes CW, Krych AJ, Cummings NM et al (2021) Pre-operative patella alta does not affect midterm clinical outcomes and survivorship of patellofemoral arthroplasty. Knee Surg Sports Traumatol Arthrosc 29:1670–1677

    Article  PubMed  Google Scholar 

  3. Bozic K, Yu H, Zywiel MG, Li L, Lin Z, Simoes JL et al (2020) Quality measure public reporting is associated with improved outcomes following hip and knee replacement. J Bone Joint Surg Am 102:1799–1806

    Article  PubMed  Google Scholar 

  4. Bunyoz KI, Lustig S, Troelsen A (2019) Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:2226–2237

    Article  PubMed  Google Scholar 

  5. Clement ND, Howard TA, Immelman RJ, MacDonald D, Patton JT, Lawson GM et al (2019) Patellofemoral arthroplasty versus total knee arthroplasty for patients with patellofemoral osteoarthritis: equal function and satisfaction but higher revision rate for partial arthroplasty at a minimum eight years’ follow-up. Bone Joint J. 101-B:41–46

    Article  CAS  PubMed  Google Scholar 

  6. Copay AG, Eyberg B, Chung AS, Zurcher KS, Chutkan N, Spangehl MJ (2018) Minimum clinically important difference: current trends in the orthopaedic literature, part II: lower extremity: a systematic review. JBJS Rev 6:e2

    Article  PubMed  Google Scholar 

  7. Crossley KM, Bennell KL, Cowan SM, Green S (2004) Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 85:815–822

    Article  PubMed  Google Scholar 

  8. Dahm DL, Kalisvaart MM, Stuart MJ, Slettedahl SW (2014) Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis. Knee Surg Sports Traumatol Arthrosc 22:2554–2559

    Article  PubMed  Google Scholar 

  9. deDeugd CM, Pareek A, Krych AJ, Cummings NM, Dahm DL (2017) Outcomes of patellofemoral arthroplasty based on radiographic severity. J Arthroplasty 32:1137–1142

    Article  PubMed  Google Scholar 

  10. Dejour D, Saffarini M, Malemo Y, Pungitore M, Valluy J, Nover L et al (2019) Early outcomes of an anatomic trochlear-cutting patellofemoral arthroplasty: patient selection is key. Knee Surg Sports Traumatol Arthrosc 27:2297–2302

    Article  PubMed  Google Scholar 

  11. Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM et al (2008) Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 39:381-388 vii

    Article  PubMed  Google Scholar 

  12. Gagnier JJ, Mullins M, Huang H, Marinac-Dabic D, Ghambaryan A, Eloff B et al (2017) A systematic review of measurement properties of patient-reported outcome measures used in patients undergoing total knee arthroplasty. J Arthroplasty 32:1688-1697 e1687

    Article  PubMed  Google Scholar 

  13. Grevnerts HT, Terwee CB, Kvist J (2015) The measurement properties of the IKDC-subjective knee form. Knee Surg Sports Traumatol Arthrosc 23:3698–3706

    Article  PubMed  Google Scholar 

  14. Imhoff AB, Feucht MJ, Bartsch E, Cotic M, Pogorzelski J (2019) High patient satisfaction with significant improvement in knee function and pain relief after mid-term follow-up in patients with isolated patellofemoral inlay arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:2251–2258

    Article  PubMed  Google Scholar 

  15. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    Article  CAS  PubMed  Google Scholar 

  16. Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415

    Article  CAS  PubMed  Google Scholar 

  17. Joseph MN, Achten J, Parsons NR, Costa ML, Collaborators PATT (2020) The PAT randomized clinical trial. Bone Joint J 102-B:310–318

    Article  PubMed  Google Scholar 

  18. Kamikovski I, Dobransky J, Dervin GF (2019) The clinical outcome of patellofemoral arthroplasty vs total knee arthroplasty in patients younger than 55 years. J Arthroplasty 34:2914–2917

    Article  PubMed  Google Scholar 

  19. Karhade AV, Bono CM, Schwab JH, Tobert DG (2021) Minimum clinically important difference: a metric that matters in the age of patient-reported outcomes. J Bone Joint Surg Am 103:2331–2337

    Article  PubMed  Google Scholar 

  20. Konan S, Haddad FS (2016) Midterm outcome of avon patellofemoral arthroplasty for posttraumatic unicompartmental osteoarthritis. J Arthroplasty 31:2657–2659

    Article  PubMed  Google Scholar 

  21. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  22. Kunze KN, Bart JA, Ahmad M, Nho SJ, Chahla J (2021) Large heterogeneity among minimal clinically important differences for hip arthroscopy outcomes: a systematic review of reporting trends and quantification methods. Arthroscopy 37:1028-1037 e1026

    Article  PubMed  Google Scholar 

  23. Kvien TK, Heiberg T, Hagen KB (2007) Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 66(Suppl 3):iii40-41

    PubMed  PubMed Central  Google Scholar 

  24. Makhni EC, Baumhauer JF, Ayers D, Bozic KJ (2019) Patient-reported outcome measures: how and why they are collected. Instr Course Lect 68:675–680

    PubMed  Google Scholar 

  25. Metcalfe AJ, Ahearn N, Hassaballa MA, Parsons N, Ackroyd CE, Murray JR et al (2018) The Avon patellofemoral joint arthroplasty: two- to 18-year results of a large single-centre cohort. Bone Joint J 100-B:1162–1167

    Article  CAS  PubMed  Google Scholar 

  26. Nwachukwu BU, Chang B, Fields K, Rebolledo BJ, Nawabi DH, Kelly BT et al (2017) Defining the “substantial clinical benefit” after arthroscopic treatment of femoroacetabular impingement. Am J Sports Med 45:1297–1303

    Article  PubMed  Google Scholar 

  27. Odgaard A, Kappel A, Madsen F, Kristensen PW, Stephensen S, Attarzadeh AP (2022) Patellofemoral arthroplasty results in better time-weighted patient-reported outcomes after 6 years than TKA: a randomized controlled trial. Clin Orthop Relat Res 480:1707–1718

    Article  PubMed  Google Scholar 

  28. Ruzbarsky JJ, Marom N, Marx RG (2018) Measuring quality and outcomes in sports medicine. Clin Sports Med 37:463–482

    Article  PubMed  Google Scholar 

  29. Shubin Stein BE, Brady JM, Grawe B, Tuakli-Wosornu Y, Nguyen JT, Wolfe E et al (2017) Return to activities after patellofemoral arthroplasty. Am J Orthop (Belle Mead NJ) 46:E353–E357

    PubMed  Google Scholar 

  30. Squitieri L, Bozic KJ, Pusic AL (2017) The role of patient-reported outcome measures in value-based payment reform. Value Health 20:834–836

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tishelman JC, Kahlenberg CA, Nwachukwu BU, Gruskay J, Strickland SM (2019) Patient satisfaction reporting for patellofemoral arthroplasty is significantly lacking: a systematic review. Phys Sportsmed 47:270–274

    Article  PubMed  Google Scholar 

  32. Villa JC, Paoli AR, Nelson-Williams HW, Badr RN, Harper KD (2021) Onlay patellofemoral arthroplasty in patients with isolated patellofemoral arthritis: a systematic review. J Arthroplasty 36:2642–2649

    Article  PubMed  Google Scholar 

  33. Walker T, Perkinson B, Mihalko WM (2012) Patellofemoral arthroplasty: the other unicompartmental knee replacement. J Bone Joint Surg Am 94:1712–1720

    Article  PubMed  Google Scholar 

  34. Wei DH, Hawker GA, Jevsevar DS, Bozic KJ (2015) Improving value in musculoskeletal care delivery: AOA critical issues. J Bone Joint Surg Am 97:769–774

    Article  PubMed  Google Scholar 

  35. Willekens P, Victor J, Verbruggen D, Vande Kerckhove M, Van Der Straeten C (2015) Outcome of patellofemoral arthroplasty, determinants for success. Acta Orthop Belg 81:759–767

    PubMed  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Kyle N. Kunze, Guilherme Palhares, Tyler J. Uppstrom, Paige Hinkley, Morgan Rizy, Andreas H. Gomoll, Beth E. Shubin Stein & Sabrina M. Strickland

Authors
  1. Kyle N. Kunze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guilherme Palhares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tyler J. Uppstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paige Hinkley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Morgan Rizy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas H. Gomoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beth E. Shubin Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sabrina M. Strickland
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KNK: Writing of initial manuscript, methodology, statistical analysis, supervision, manuscript revision. GP, PH, MR, TJU: Writing of initial manuscript, data acquisition. SMS, BESS, AHG: Writing and revision of the initial manuscript.

Corresponding author

Correspondence to Kyle N. Kunze.

Ethics declarations

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study received institutional board approval prior to commencement.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 21 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kunze, K.N., Palhares, G., Uppstrom, T.J. et al. Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 3299–3306 (2023). https://doi.org/10.1007/s00167-023-07341-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07341-y

Keywords

Search

Navigation