Mental Health Effects on the Minimal Clinically Important Difference in Total Joint Arthroplasty

Mehdi S. Salimy, Aris Paschalidis, Jacquelyn Dunahoe, Antonia F. Chen, Todd M. O'Brien, Rachel C. Sisodia, Hany S. Bedair, Christopher M. Melnic
November 2022
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Abstract

Introduction: The impact of mental health on patient-reported outcome measures (PROMs) is not fully understood in total joint arthroplasty (TJA). Thus, we investigated the relationship between mental health diagnoses (MHD) and the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in primary TJA (pTJA) and revision TJA (rTJA).

Methods: From 2015 to 2021, retrospective data were collected using relevant CPT and ICD-10 codes with completed Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS), Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, or PROMIS Global- Physical questionnaires. PROM scores and MCID-I/MCID-W rates, with subgroup analyses and logistic regressions, were compared across surgeries.

Results: Data included 4,644 patients (4,271 pTJAs/373 rTJAs). pTHA and pTKA demonstrated differing outcomes for PF10a (MCID-I: 73% vs. 65%, p< 0.001; MCID-W: 5.8% vs. 11%, p< 0.001), PROMIS Global-Mental (MCID-I: 42% vs. 45%, p=0.044), and PROMIS Global-Physical (MCID-I: 68% vs. 60%, p< 0.001; MCID-W: 11% vs. 14%, p< 0.001), respectively. In pTHA, a MHD affected outcomes for HOOS-PS (MCID-I: 80% vs. 86%, p=0.004; MCID-W: 6.3% vs. 3.4%, p=0.006), PF10a (MCID-I: 68% vs. 77%, p< 0.001), PROMIS Global-Mental (MCID-I: 39% vs. 44%, p=0.019), and PROMIS Global-Physical (MCID-I: 62% vs. 73%, p=0.001; MCID-W: 30% vs. 26%, p< 0.001) compared to only PROMIS Global-Physical (MCID-I: 56% vs. 62%, p=0.003) in pTKA. Comparing pTHA to rTHA and pTKA to rTKA demonstrated statistically higher MCID-I and lower MCID-W rates for nearly all five PROM measures for pTHA/TKA. Almost no differences were demonstrated between the rTHA/rTKA cohorts, even when controlling for a MHD.

Conclusion: The presence of a MHD had a greater negative influence on pTHA patients than pTKA patients. Patients who underwent rTJA had lower MCID-I rates, higher MCID-W rates, and lower PROM scores despite less influence from a MHD.

Type
Poster presentation
Publication
Presented at: American Association of Hip and Knee Surgeons Annual Meeting
total joint arthroplasty TJA total hip arthroplasty THA total knee arthroplasty TKA mental health physical function minimal clinically important difference MCID PROM PROMIS post-operative outcome
Aris Paschalidis
Aris Paschalidis
Medical Student

My research interests include health analytics, infectious diseases, and artificial intelligence.

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