Related Experiment Video
Updated: Jul 26, 2025
Software-Assisted Quantitative Measurement of Osteoarthritic Subchondral Bone Thickness
Published on: March 18, 2022
Intersurgeon Variability of Minimal Clinically Important Difference for Worsening Achievement Rates After Total Joint
Amy Z Blackburn1, Andrew Homere1, Kyle Alpaugh1
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
Background:
Using the Patient-Reported Outcome Measurement Information System, we sought to evaluate surgeon performance variability via minimal clinically important difference for worsening (MCID-W) achievement rates in primary and revision total knee and hip arthroplasty.
Methods:
This retrospective study analyzed 3,496 primary total hip arthroplasty (THA), 4,622 primary total knee arthroplasty (TKA), 592 revision THA, and 569 revision TKA patients. Patient factors collected included demographics, comorbidities, and Patient-Reported Outcome Measurement Information System physical function short form 10a scores. Surgeon factors collected included caseload, years of experience, and fellowship training. The MCID-W rate was calculated as the percent of patients in each surgeon's cohort who achieved MCID-W. Distribution was presented via a histogram with associated average, standard deviation, range, and interquartile range (IQR). Linear regressions were performed to evaluate the potential correlation between surgeon- and patient-level factors with MCID-W rate.
Results:
The average MCID-W rates of the surgeons represented in the primary THA and TKA cohorts were 12.7 ± 9.2% (range, 0 to 35.3%; IQR, 6.7 to 15.5%) and 18.0 ± 8.2% (range, 0 to 36%; IQR, 14.3 to 22.0%). The average MCID-W rates among the revision THA and TKA surgeons were 36.0 ± 22.2% (range, 9.1 to 90%; IQR, 25.0 to 41.4%) and 21.2 ± 7.7% (range, 8.1 to 37.0%; IQR, 16.6 to 25.4%). Strong correlations were not found between patient- or surgeon-level factors and MCID-W rate of the surgeon.
Conclusion:
We demonstrated variance in MCID-W achievement rates across surgeons in both primary and revision joint arthroplasty, independent of patient- or surgeon-level factors.
Insights
Surgeon performance in joint replacement surgery shows significant variability in patient-reported outcomes. This study found differences in minimal clinically important difference for worsening (MCID-W) achievement rates among surgeons, unrelated to experience or patient factors.
Area of Science:
- Orthopedic Surgery
- Patient-Reported Outcomes
- Surgical Quality Improvement
Background:
- Assessing surgeon performance variability is crucial for improving joint arthroplasty outcomes.
- The Patient-Reported Outcome Measurement Information System (PROMIS) offers a standardized method for evaluating patient function.
- Minimal Clinically Important Difference for worsening (MCID-W) provides a threshold for meaningful outcome changes.
Purpose of the Study:
- To evaluate surgeon performance variability in primary and revision total knee arthroplasty (TKA) and total hip arthroplasty (THA).
- To determine achievement rates of MCID-W across surgeons.
- To identify potential correlations between surgeon/patient factors and MCID-W rates.
Main Methods:
- Retrospective analysis of 3,496 primary THA, 4,622 primary TKA, 592 revision THA, and 569 revision TKA patients.
- Collected patient data included demographics, comorbidities, and PROMIS physical function scores.
- Surgeon data included caseload, experience, and fellowship training; MCID-W rate calculated per surgeon.
Main Results:
- Average MCID-W rates varied significantly across surgeons: primary THA (12.7%), primary TKA (18.0%), revision THA (36.0%), and revision TKA (21.2%).
- Wide ranges and interquartile ranges observed for MCID-W rates within each surgical category.
- No strong correlations found between surgeon-level factors (caseload, experience) or patient-level factors and MCID-W rates.
Conclusions:
- Significant variability exists in MCID-W achievement rates among surgeons performing primary and revision joint arthroplasty.
- This variability appears independent of identified patient and surgeon-level factors.
- Further research is needed to understand the drivers of performance variation in joint replacement surgery.
