Predicting whether patients will achieve minimal clinically important differences following hip or knee arthroplasty.

A substantial fraction of patients undergoing knee arthroplasty (KA) or hip arthroplasty (HA) do not achieve an improvement as high as the minimal clinically important difference (MCID), i.e. do not achieve a meaningful improvement. Using three patient-reported outcome measures (PROMs), our aim was: 1) to assess machine learning (ML), the simple pre-surgery PROM score, and logistic-regression (LR)-derived performance in their prediction of whether patients undergoing HA or KA achieve an improvement as high or higher than a calculated MCID; and 2) to test whether ML is able to outperform LR or pre-surgery PROM scores in predictive performance. MCIDs were derived using the change difference method in a sample of 1,843 HA and 1,546 KA patients. An artificial neural network, a gradient boosting machine, least absolute shrinkage and selection operator (LASSO) regression, ridge regression, elastic net, random forest, LR, and pre-surgery PROM scores were applied to predict MCID for the following PROMs: EuroQol five-dimension, five-level questionnaire (EQ-5D-5L), EQ visual analogue scale (EQ-VAS), Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS). Predictive performance of the best models per outcome ranged from 0.71 for HOOS-PS to 0.84 for EQ-VAS (HA sample). ML statistically significantly outperformed LR and pre-surgery PROM scores in two out of six cases. MCIDs can be predicted with reasonable performance. ML was able to outperform traditional methods, although only in a minority of cases.

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© 2023 Author(s) et al.

Déclaration de conflit d'intérêts

D. Schrednitzki reports payments for lectures and courses on knee arthroplasty and robotics from Zimmer Biomet, unrelated to this study. R. Busse reports institutional grants from Roche and Stryker, and speaker payments from AbbVie, all of which are unrelated to this study. R. Busse is also involved with the Government Commission on Hospital Reform. A. Halder reports royalties or licenses, speaker payments, and support for attending meetings and/or travel from Zimmer Biomet and DePuy, unrelated to this study. A. Halder is also President of the German Orthopaedic Society (DGOOC) 2022 Board Member European Knee Society. C. Pross is employed by Stryker, and reports stock in Stryker, unrelated to this study.