Can Patient-Reported Outcome Measurement Information System Measures Differentiate Patients Who Will Undergo Hip and Knee Total Joint Arthroplasty: A Retrospective Case-Control Study

New Patient PROMIS Scores of Patients Presenting with Low Back Pain Predict Time to Elective Spine Surgery

Introduction

This study aims to determine whether Patient-Reported Outcomes Measurement Information System (PROMIS) domain scores can predict elective spine surgery within 1 year of initial clinic evaluation.

Methods

A retrospective query for all new patient spine clinic visits with diagnosis codes related to lower back pain was carried out at a single academic institution. A chart review was conducted to collect sociodemographic variables, clinic visit details, and PROMIS domain scores (PF [Physical Function], PI [Pain Interference], Depression, and Global Health-Physical and Global Health-Mental). Patients were divided into Surgery and No Surgery, and for time to surgery, a subanalysis was also carried out.

Results

Overall, 116 (8.4%) of 1,387 new patients underwent surgery within 1 year. Race, Surgeon vs. Advanced Practice Provider (APP), and whether advanced imaging (MRI or CT myelogram) was available for interpretation were statistically associated with undergoing surgery. Patients in the Surgery group had statistically significant worse PROMIS scores in all domains when compared with the No Surgery group, and PROMIS PI was additionally associated with Time to Surgery. Multivariate analysis identified PROMIS PI, race, presence of advanced imaging interpretation, and Surgeon vs. APP as independent predictors of Surgery vs. No Surgery; however, only race and PROMIS PI were independent predictors of Time to Surgery.

Conclusions

Worse new patient PROMIS PI scores were associated with undergoing surgery within one year of initial evaluation. To determine if PROMIS scores may help in a triage capacity to identify which patients are most appropriate for a surgeon visit versus a nonsurgical provider, further research is needed, thereby improving the efficiency of surgical care delivery.

Periprosthetic Joint Infection: Are Patients Still Better off Than if Primary Arthroplasty Had Not Been Performed?

BACKGROUND

This study sought to evaluate patient-reported outcome measures (PROMs) before primary total joint arthroplasty (TJA) and after successful treatment for periprosthetic joint infection (PJI), with the hypothesis that patients still demonstrate clinical improvement despite the occurrence of PJI.

METHODS

A single tertiary academic center's institutional database was retrospectively reviewed for patients who underwent primary TJA, developed PJI, and were managed for PJI from January 2019 to December 2023. Patients who did not have PROMs recorded were excluded from the study. Preoperative and postoperative generic and joint-specific PROMs were collected. Patient preprimary and postfinal revision surgery for PJI PROMs were subsequently compared. The minimum follow-up after PJI treatment was 6 months. A total of 55 patients (31 total knee arthroplasty and 24 total hip arthroplasty) were included with a mean follow-up of 1.8 years (range, 6 months to 4.5 years). All PJIs were managed via debridement, antibiotics, and implant retention, 1-stage, 1.5-stage, 2-stage revision, or resection arthroplasty.

RESULTS

After final revision surgery for PJI in total knee arthroplasty, patients had lower median patient-reported outcome measure information system (PROMIS) pain interference scores than before their primary surgery (62.0 [55.0, 67.0] versus 67.0 [65.0, 70.5]; P < 0.01). However, median PROMIS physical function postfinal revision for PJI and preprimary scores were similar (38.0 [33.0, 42.0] versus 34.0 [29.5, 40.0]; P = 0.08). After final revision surgery for PJI in total hip arthroplasty, patients had lower median PROMIS pain interference scores than before their primary surgery (57.5 [53.8, 64.0] versus 68.0 [66.5, 74.0]; P < 0.01). After final revision surgery for PJI, patients also had higher median PROMIS physical function scores than before their primary surgery (39.5 [33.5, 48.2] versus 29.5 [28.8, 34.2]; P < 0.01).

CONCLUSIONS

Patients who have been successfully managed for PJI show improvement in generic and joint-specific PROMs compared to their preprimary TJA PROMs.

The current utilization of the patient-reported outcome measurement information system (PROMIS) in isolated or combined total knee arthroplasty populations

Patient reported outcome measures (PROMs) are essential for clinical research and patient-centric care because they allow us to capture patient perspectives on their health condition. In knee arthroplasty, PROMs are frequently used to assess the risks and benefits of new interventions, surgical approaches, and other management strategies. A few examples of PROMs used in total knee arthroplasty (TKA) include the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Forgotten Joint Score (FJS) (collectively referred to as "legacy" PROMs). More recently, attention has been brought to another PROM called the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS was developed by the National Institute of Health (NIH) and has over 300 domains assessing various aspects of patient health, including pain, physical function, and mental health. With the use of PROMIS increasing in TKA literature, there is a need to review the advancements being made in understanding and applying PROMIS for this population. Thus, the purpose of this study is to provide insight on the utilization, advantages, and disadvantages of PROMIS within the field of knee arthroplasty and to provide a comparison to legacy PROMs.