ArticleArchives of orthopaedic and trauma surgery2025
Total joint arthroplasty patients who experience the minimal clinically important difference for worsening (MCID-W) have higher revision rates at 1, 3, and 5 years postoperatively.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe Minimal Clinically Important Difference (MCID) is critical in assessing patient-reported outcomes following total joint arthroplasty (TJA). Although many studies consider the MCID for Improvement (MCID-I), thresholds have also been defined for the MCID for Worsening (MCID-W). However, the potential impact of the MCID-W on surgical outcomes in TJA is under-investigated. This study investigated the association between the MCID-W and revision rate. MATERIALS AND
methodsThis retrospective study was performed using 2787 primary TJAs-1563 total knee arthroplasties (TKAs) and 1224 total hip arthroplasties (THAs)-with minimum five-year follow-up. Patient-Reported Outcomes Measurement Information System Physical Function Short Form 10a (PROMIS PF-10a) scores were collected preoperatively and at one-year postoperatively. Patients were classified based on experiencing MCID-I, MCID-W, or "no change" after TJA (scores between MCID-I and MCID-W). MCID-W and MCID-I values were determined by a distribution-based method. Revision-free survival was compared at 1 year, 3 years, and 5 years postoperatively.
resultsThe overall revision rate for the entire TJA cohort was 1.1% at 1 year, 1.8% at 3 years, and 2.2% at 5 years postoperatively. TJA patients who experienced MCID-W had a higher revision rate than MCID-I patients at 1 year (3.6 versus 0.8%, P < 0.001), 3 years (5.3 versus 1.1%, P < 0.001), and 5 years postoperatively (5.7 versus 1.5%, P < 0.001). Similarly, stratifying into TKAs and THAs revealed an association between MCID-W and higher revision rates. Revision-free survival curves for MCID-W patients revealed lower survival at 1 year (P < 0.001), 3 years (P < 0.001), and 5 years (P < 0.001).
conclusionsPatients experiencing the MCID-W are more likely to undergo revision surgery at 1, 3, and 5 years following both THA and TKA procedures. The MCID-W may be a useful tool to help identify postoperative THA and TKA patients at highest risk for revision surgery. Future studies utilizing MCID-W as a predictive tool are needed to determine its effectiveness in optimizing TJA patient outcomes.
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