Evaluating Measures of Clinical Meaningfulness for Patient-Reported Outcome Measures in Total Joint Arthroplasty: A Systematic Review.

Abstract

Recently, the Centers for Medicare and Medicaid Services (CMS) mandated the collection of patient-reported outcome measures (PROMs) for all primary total joint arthroplasties (TJAs), reinforcing their role in evaluating clinical outcomes. This systematic review investigated the calculation methods and anchor questions used to derive key PROM-based thresholds such as minimal clinically important difference (MCID), substantial clinical benefit (SCB), and the patient acceptable symptom state (PASS) for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR). Databases were queried for articles from 2000 to 2025 specific to the HOOS JR and KOOS JR. Articles were reviewed by two reviewers and included if they were in the English language and derived either the MCID, SCB, and/or PASS metrics specific to primary TJA procedures. Study characteristics, MCID, SCB, and/or PASS thresholds, and methods of derivation were extracted. A total of 17 studies with 44,935 patients who met the final inclusion criteria were included. With respect to the HOOS JR, 10 studies derived a distribution-based MCID (range, 3.9 to 11.0 points), six studies derived an anchor-based MCID (range, 14.8 to 38.1 points), one study derived an SCB (22 points), and three studies derived a PASS score (range, 73.5 to 81.0). Specific to the KOOS JR, nine studies derived a distribution-based MCID (range, 4.0 to 8.7 points), six derived an anchor-based MCID (range, 14.0 to 30.7 points), one derived an SCB (20 points), and two derived a PASS score (range, 63.7 to 71.0 points). Substantial variability existed in the calculation methods reported for deriving the metrics specific to the MCID, SCB, and PASS scores. As such, it is imperative to standardize methodology and utilization for the calculation of MCIDs, SCB, and PASS metrics to allow for improved assessment of PROMs specific to total joint arthroplasty.