背景
以前没有研究评估过 MCID 用于翻修全膝关节置换术 (TKA)。本研究旨在确定膝关节协会评分 (KSS) 的 MCID，用于翻修 TKA。
方法
对在单一机构接受 TKA 翻修的 270 名患者前瞻性收集的数据进行了分析。使用膝关节协会功能评分 (KSFS) 和膝关节 (KSKS) 评分以及牛津膝关节评分 (OKS) 在术前、6 个月和 2 年时进行临床评估。MCID 采用三管齐下的方法进行评估，使用 (1) 基于锚定的线性回归方法，(2) 基于锚定的方法，具有接受者操作特征 (ROC) 和曲线下面积 (AUC)，(3) 基于分布具有标准偏差 (SD) 的方法。使用的锚点是改善了 OKS ≥ 5、患者满意度和翻修 TKA 后的植入物存活率。
结果
该队列包括 70% 的女性，平均年龄为 69.0 岁，接受了单侧 TKA 翻修。使用 OKS 通过基于锚的线性回归方法确定的 MCID 为 KSFS 为 6.3，而 KSKS 为 6.6。由基于锚的 ROC 确定的 MCID 为 KSFS 的 15 至 20（AUC：满意度 = 71.8%，生存率 = 61.4%）和 KSKS 的 33 至 34 之间（AUC：满意度 = 76.3%，生存率 = 67.1%）。通过基于分布的 0.5 SD 方法确定的 MCID 对于 KSFS 为 11.7，对于 KSKS 为 11.9。
结论
KSFS 的 6.3 分和 KSKS 的 6.6 分的 MCID 是未来研究比较修订与主要 TKA 结果的有用基准。临床上，KSFS 的 MCID 介于 15 和 20 之间，KSKS 的 MCID 介于 33 和 34 之间，是区分 TKA 翻修后成功结局的患者的有力工具。植入物存活率是一种客观且自然二分法的结果测量，它补充了患者满意度的主观测量，未来的 MCID 研究可以考虑将其用作 ROC 中的锚。
证据水平
二、
"点击查看英文标题和摘要"
Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty
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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