Kohei Nishitani1, Yosuke Yamamoto2, Moritoshi Furu3, Shinichi Kuriyama4, Shinichiro Nakamura5, Hiromu Ito6, Shunichi Fukuhara7, Shuichi Matsuda8. 1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: nkohei@kuhp.kyoto-u.ac.jp. 2. Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: yamamoto.yosuke.5n@kyoto-u.ac.jp. 3. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: morifuru@gmail.com. 4. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: kuriyama@kuhp.kyoto-u.ac.jp. 5. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: shnk@kuhp.kyoto-u.ac.jp. 6. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: hiromu@kuhp.kyoto-u.ac.jp. 7. Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: fukuhara.shunichi.6m@kyoto-u.ac.jp. 8. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, Kyoto, 606-8507, Japan. Electronic address: smat522@kuhp.kyoto-u.ac.jp.
Abstract
BACKGROUND: The new Knee Society Score (2011KSS) has been used to evaluate post-operative outcomes after total knee arthroplasty (TKA). However, there is no minimum clinically important difference (MCID) for 2011KSS. The purpose of this study is to define MCID of 2011KSS after TKA. METHODS: Patients who underwent primary TKA for primary knee osteoarthritis between April 2012 and December 2016 were included in the study. The Japanese version of 2011KSS and original Knee Society Score (OKSS) were recorded preoperatively and at one-year postoperatively. With improvement in pain score of OKSS as an anchor, an anchor-based approach was used to identify the MCID of 2011KSS. The improvement in pain of OKSS was classified into 5 categories. The MCID was determined using a linear regression analysis of delta 2011KSS against improvement in the category of pain in OKSS. The MCID for 2011KSS expectation was not calculated because the items of pre- and post-operative questionnaires were different. RESULTS: Five hundred and twenty-two cases were enrolled (age: 74.8 ± 7.3 years, female: 80.0%). After 1-year follow-up, 344 TKAs were finally included (age: 74.6 ± 7.1 years, female: 77.9%). Linear regression analyses showed that MCID for 2011KSS was 1.9 (95% confidential interval (CI): 1.3-2.5) in symptom, 2.2 (95%CI: 1.4-2.9) in satisfaction, and 4.1 (95%CI: 2.5-5.7) in functional activities. CONCLUSIONS: MCID for 2011KSS was successfully calculated. These MCID values make the 2011KSS a more efficient tool for evaluating the physical activities of the populations of patients undergoing TKA. These MCID values can also be used to calculate sample size to evaluate the power of a study in designing clinical studies.
BACKGROUND: The new Knee Society Score (2011KSS) has been used to evaluate post-operative outcomes after total knee arthroplasty (TKA). However, there is no minimum clinically important difference (MCID) for 2011KSS. The purpose of this study is to define MCID of 2011KSS after TKA. METHODS:Patients who underwent primary TKA for primary knee osteoarthritis between April 2012 and December 2016 were included in the study. The Japanese version of 2011KSS and original Knee Society Score (OKSS) were recorded preoperatively and at one-year postoperatively. With improvement in pain score of OKSS as an anchor, an anchor-based approach was used to identify the MCID of 2011KSS. The improvement in pain of OKSS was classified into 5 categories. The MCID was determined using a linear regression analysis of delta 2011KSS against improvement in the category of pain in OKSS. The MCID for 2011KSS expectation was not calculated because the items of pre- and post-operative questionnaires were different. RESULTS: Five hundred and twenty-two cases were enrolled (age: 74.8 ± 7.3 years, female: 80.0%). After 1-year follow-up, 344 TKAs were finally included (age: 74.6 ± 7.1 years, female: 77.9%). Linear regression analyses showed that MCID for 2011KSS was 1.9 (95% confidential interval (CI): 1.3-2.5) in symptom, 2.2 (95%CI: 1.4-2.9) in satisfaction, and 4.1 (95%CI: 2.5-5.7) in functional activities. CONCLUSIONS: MCID for 2011KSS was successfully calculated. These MCID values make the 2011KSS a more efficient tool for evaluating the physical activities of the populations of patients undergoing TKA. These MCID values can also be used to calculate sample size to evaluate the power of a study in designing clinical studies.