PMID- 34115533
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 49
IP  - 9
DP  - 2021 Jul
TI  - The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors 
      Related to Achievement of the MCID After Medial Opening Wedge High Tibial 
      Osteotomy for Knee Osteoarthritis.
PG  - 2406-2415
LID - 10.1177/03635465211016853 [doi]
AB  - BACKGROUND: Many approaches have been used to determine the minimal clinically 
      important difference (MCID) in patients undergoing total knee arthroplasty, but 
      the MCID for outcome measures after medial opening wedge high tibial osteotomy 
      (MOWHTO) for the treatment of medial compartment knee osteoarthritis (OA) has not 
      been reported. PURPOSE: To define the MCID for the Western Ontario and McMaster 
      Universities Arthritis Index (WOMAC) after MOWHTO and to identify risk factors 
      for not achieving the MCID. STUDY DESIGN: Case-control study; Level of evidence, 
      3. METHODS: Among patients with medial compartment knee OA who underwent MOWHTO, 
      174 patients who were followed for 2 years were included in the study. The MCID 
      and substantial clinical benefit (SCB) for the WOMAC were determined using the 
      anchor-based method with a 15-item questionnaire. Preoperative OA severity was 
      measured by the Kellgren-Lawrence (K-L) grading system, and the acceptable range 
      of the postoperative weightbearing line ratio was 50% to 70%. Patients were 
      divided into 2 groups based on whether the MCID and SCB were achieved, and then 
      factors related to failure to achieve the MCID and SCB were analyzed using 
      multivariate logistic regression analysis. RESULTS: The MCID for the WOMAC was 
      4.2 points for the pain subscale, 1.9 points for the stiffness subscale, 10.1 
      points for the function subscale, and 16.1 points for the total. Additionally, 
      the SCB for the WOMAC was 6.4 for pain, 2.6 for stiffness, 16.4 for function, and 
      25.3 for the total. Overall, 116 (66.7%), 99 (56.9%), 127 (73.0%), and 128 
      (73.6%) patients achieved the MCID for the WOMAC pain, stiffness, function, and 
      total, respectively, after MOWHTO. The odds of not achieving the MCID for the 
      WOMAC total were 1.09 times greater (95% CI, 1.05-1.13; P < .001) in patients 
      with a low preoperative WOMAC total score (cutoff values: 10.5 for pain, 3.5 for 
      stiffness, 34.5 for function, and 51.0 for the total), 11.77 times greater (95% 
      CI, 3.68-37.70; P < .001) in patients with K-L grade 4 OA compared with K-L 
      grades 2 or 3 OA, and 8.39 times greater (95% CI, 2.98-23.63; P < .001) in 
      patients with undercorrection or overcorrection. A low preoperative WOMAC score, 
      K-L grade 4 OA, and undercorrection or overcorrection were also associated with 
      not achieving the SCB for the WOMAC total (all P < .05). CONCLUSION: Patients 
      treated with a MOWHTO require a 16.1-point improvement in the WOMAC total score 
      to achieve a MCID from the procedure. Low preoperative WOMAC scores, severe OA, 
      and undercorrection or overcorrection were related to failure to achieve the 
      MCID.
FAU - Kim, Man Soo
AU  - Kim MS
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
FAU - Koh, In Jun
AU  - Koh IJ
AD  - Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of 
      Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
FAU - Choi, Keun Young
AU  - Choi KY
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
FAU - Sung, Yong Gyu
AU  - Sung YG
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
FAU - Park, Dong Chul
AU  - Park DC
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
FAU - Lee, Hyo Jin
AU  - Lee HJ
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
FAU - In, Yong
AU  - In Y
AD  - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, 
      The Catholic University of Korea, Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
DEP - 20210611
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Case-Control Studies
MH  - Humans
MH  - Knee Joint/surgery
MH  - Minimal Clinically Important Difference
MH  - *Osteoarthritis, Knee/surgery
MH  - Osteotomy
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Western Ontario and McMaster Universities Arthritis Index (WOMAC)
OT  - knee osteoarthritis
OT  - medial opening wedge high tibial osteotomy
OT  - minimal clinically important difference (MCID)
EDAT- 2021/06/12 06:00
MHDA- 2021/08/10 06:00
CRDT- 2021/06/11 17:12
PHST- 2021/06/12 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2021/06/11 17:12 [entrez]
AID - 10.1177/03635465211016853 [doi]
PST - ppublish
SO  - Am J Sports Med. 2021 Jul;49(9):2406-2415. doi: 10.1177/03635465211016853. Epub 
      2021 Jun 11.