{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:11:38Z","timestamp":1788952298630,"version":"build-2803163510"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The U.S. Centers for Medicare &amp; Medicaid Services (CMS) has set the substantial clinical benefit (SCB) for the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) after primary total knee arthroplasty (TKA) at 20 points. We aimed to determine the percentages of patients who achieved the minimal clinically important difference (MCID) and the SCB for KOOS-JR at 1 year following TKA and to evaluate factors associated with benchmark achievement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We queried the American Joint Replacement Registry (AJRR) and screened 1,284,404 primary TKA cases performed from 2018 to 2023. We determined attainment of the KOOS-JR distribution-based MCID (7.5), anchor-based MCID (14), and SCB (20) at 12 months by each patient. Associations of covariates with the achievement of the MCIDs and the SCB were evaluated using a generalized linear model for binary outcomes that accounted for clustering within institutions. Unadjusted and adjusted odds ratios (ORs) for the outcomes of interest with 95% confidence intervals (CIs) were reported. Covariates included the preoperative KOOS-JR, sex, race or ethnicity, body mass index (BMI), Charlson Comorbidity Index (CCI), fixation type, use of technology, year of the procedure, region, institution type, teaching status, and number of beds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Linked scores were recorded by 64,773 patients. The mean patient age was 68.35 \u00b1 8.60 years, 61.29% of patients were female, and 83.52% of patients were non-Hispanic White. The KOOS-JR threshold achievement rate was 86.8% for the calculated distribution-based MCID, 76.5% for the anchor-based MCID, and 65.7% for the SCB. Patients with higher preoperative scores (adjusted OR, 0.93 [95% CI, 0.93 to 0.93]; p &lt; 0.001), Asian patients (adjusted OR, 0.59 [95% CI, 0.46 to 0.74]; p &lt; 0.001), Black patients (adjusted OR, 0.55 [95% CI, 0.49 to 0.62]; p &lt; 0.001), Hispanic patients (adjusted OR, 0.71 [95% CI, 0.51 to 0.99]; p = 0.042), non-Hispanic patients of other races (adjusted OR, 0.84 [95% CI, 0.74 to 0.95]; p = 0.007), male patients (adjusted OR, 0.89 [95% CI, 0.85 to 0.94]; p &lt; 0.001), and patients with higher BMI (adjusted OR, 0.93 [95% CI, 0.87 to 0.99]; p = 0.025) showed lower odds of achieving the SCB. A CCI of \u22655 was additionally found to be associated with lower odds of achieving the distribution-based MCID (adjusted OR, 0.89 [95% CI, 0.79 to 0.99]; p = 0.032) and anchor-based MCID (adjusted OR, 0.89 [95% CI, 0.81 to 0.97]; p = 0.012).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The CMS relatively arbitrarily defined the SCB at a value that is too high for an operation that routinely yields &gt;80% patient satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.00952","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:00:30Z","timestamp":1769713230000},"page":"1092-1099","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Substantial Clinical Benefit After Total Knee Arthroplasty Has Been Set Too High"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6577-5224","authenticated-orcid":false,"given":"Leo","family":"Zalikha","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5544-275X","authenticated-orcid":false,"given":"Kuan-lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1245-0385","authenticated-orcid":false,"given":"Alexa K.","family":"Pius","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4295-9450","authenticated-orcid":false,"given":"Marcel","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1234-3468","authenticated-orcid":false,"given":"Isabella","family":"Zaniletti","sequence":"additional","affiliation":[{"name":"Registries and Data Science Department, American Academy of Orthopaedic Surgeons, Rosemont, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1693-218X","authenticated-orcid":false,"given":"James I.","family":"Huddleston","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"9","key":"bib1-20260909","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.3899\/jrheum.170990","article-title":"Rates of total joint replacement in the United States: future projections to 2020-2040 using the 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