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Does clinically important change in function after knee replacement guarantee good absolute function? The multicenter

Jessica L Maxwell1, David T Felson, Jingbo Niu

  • 1From the Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences, Boston University; Clinical Epidemiology Training Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.

The Journal of Rheumatology
|December 3, 2013
PubMed
Summary
This summary is machine-generated.

Many knee replacement patients achieve acceptable function, but fewer reach clinically important improvement. This study highlights the difference between a good outcome and significant functional gains after total knee replacement (TKR).

Keywords:
KNEE REPLACEMENTOUTCOMESPHYSICAL FUNCTION

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Area of Science:

  • Orthopedics
  • Rheumatology
  • Rehabilitation Medicine

Background:

  • Poor functional outcomes are common after knee replacement surgery.
  • Estimates of functional outcome prevalence vary due to differing assessment methods.
  • The relationship between functional improvement and achieving a good functional state post-knee replacement is not well understood.

Purpose of the Study:

  • To evaluate the attainment of functional improvement and acceptable function after total knee replacement (TKR).
  • To assess the agreement between achieving a minimal clinically important improvement (MCII) and a patient acceptable symptom state (PASS) post-TKR.
  • To explore the influence of pre-operative functional status on post-TKR outcomes.

Main Methods:

  • Analysis of data from The Multicenter Osteoarthritis (MOST) Study.
  • Determination of the prevalence of MCII (≥ 14.2/68 point improvement) and PASS (≤ 22/68 post-TKR score) on the WOMAC Physical Function subscale at least 6 months after TKR.
  • Assessment of outcome co-occurrence and prevalence based on pre-TKR functional status.

Main Results:

  • Out of 228 TKR subjects, 71% achieved PASS, while only 44% achieved MCII.
  • A high degree of overlap was observed: 93% of those achieving MCII also achieved PASS.
  • However, 54% of subjects not meeting MCII still achieved PASS, indicating partial agreement.
  • Baseline functional status significantly impacted the attainment of both MCII and PASS.

Conclusions:

  • There is only partial agreement between achieving a good functional level (PASS) and a clinically important improvement (MCII) after TKR.
  • Patients are more likely to report an acceptable symptom state than to achieve a significant functional improvement following knee replacement.
  • Pre-operative function influences post-operative outcomes, underscoring the need for personalized treatment goals.