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Inadequate Classification of Poor Response After Total Knee Arthroplasty: A Comparative Analysis of 15 Definitions Using Data From the Dutch Arthroplasty Register and the Osteoarthritis Initiative Database.
Te Molder, Malou E M; Dowsey, Michelle M; Smolders, José M H; van Steenbergen, Liza N; van den Ende, Cornelia H M; Heesterbeek, Petra J C.
Afiliação
  • Te Molder MEM; Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands.
  • Dowsey MM; Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.
  • Smolders JMH; Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.
  • van Steenbergen LN; Dutch Arthroplasty Register (LROI), 's-Hertogenbosch, the Netherlands.
  • van den Ende CHM; Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Heesterbeek PJC; Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands.
J Arthroplasty ; 39(10): 2483-2489, 2024 Oct.
Article em En | MEDLINE | ID: mdl-38759818
ABSTRACT

BACKGROUND:

Variations in defining poor response to total knee arthroplasty (TKA) impede comparisons of response after TKA over time and across hospitals. This study aimed to compare the prevalence, overlap, and discriminative accuracy of 15 definitions of poor response after TKA using 2 databases.

METHODS:

Data of patients one year after primary TKA from the Dutch Arthroplasty Register (n = 12,275) and the Osteoarthritis Initiative database (n = 204) were used to examine the prevalence, overlap (estimated by Cohen's kappa), and discriminative accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and Youden index) of 15 different definitions of poor response after TKA. In the absence of a gold standard for measuring poor response to TKA, the numeric rating scale satisfaction (≤ 6 'poor responder') and the global assessment of knee impact (dichotomized ≥ 4 'poor responder') were used as anchors for assessing discriminative accuracy for the Dutch Arthroplasty Register and Osteoarthritis Initiative dataset, respectively. These anchors were chosen based on a prior qualitative study that identified (dis)satisfaction as a central theme of poor responses to TKA by patients and knee specialists.

RESULTS:

The median (25th to 75th percentile) prevalence of poor responders in the examined definitions was 18.5% (14.0 to 25.5%), and the median Cohen's kappa for the overlap between pairs of definitions was 0.41 (0.32 to 0.59). Median (25th to 75th percentile) sensitivity was 0.45 (0.39 to 0.54), specificity was 0.86 (0.82 to 0.94), positive predictive value was 0.45 (0.34 to 0.62), negative predictive value was 0.89 (0.87 to 0.89), and the Youden index was 0.36 (0.20 to 0.43).

CONCLUSIONS:

This study found a lack of overlap between different definitions of poor response to TKA. None of the examined definitions adequately classified poor responders to TKA. In contrast, the absence of a poor response could be classified with confidence.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sistema de Registros / Artroplastia do Joelho / Osteoartrite do Joelho Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sistema de Registros / Artroplastia do Joelho / Osteoartrite do Joelho Idioma: En Ano de publicação: 2024 Tipo de documento: Article