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. 2017 Apr;32(4):1153-1158.e1.
doi: 10.1016/j.arth.2016.11.007. Epub 2016 Nov 15.

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

Daniel L Riddle  1 , Gregory J Golladay  2 , William A Jiranek  2 , Robert A Perera  3
Affiliations

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

Daniel L Riddle et al. J Arthroplasty. 2017 Apr.

Abstract

Background: Instruments designed to predict the extent of pain and function following knee arthroplasty (KA) recovery has strong potential to guide patients and clinicians in shared decision making. Our purpose was to test the external validity of a recently developed prognostic instrument designed to estimate the probability of nonresponse following KA.

Methods: We used data from the Osteoarthritis Initiative (OAI), a 9-year multisite National Institutes of Health study designed to examine the natural history of knee osteoarthritis in 4796 subjects. A total of 427 subjects underwent KA over the study period. Dowsey et al examined the prognostic role of obesity, general mental health, pain and function, and Kellgren and Lawrence knee osteoarthritis grades. Calibration of the prognostic model was determined using a calibration curve. The c-statistic was used to indicate discrimination of the model.

Results: In the primary analysis, 63 (19.3%) of 326 subjects in OAI were classified as nonresponders. The calibration curve generated from OAI data indicated poor calibration relative to the recently developed instrument. Discrimination as measured by the c-statistic was 0.76.

Conclusion: The external validity of the prognostic instrument was partially supported. While discrimination of the model was very similar to the recently developed instrument, calibration was poor indicating poor agreement between actual vs predicted probabilities of nonresponse. Western Ontario and McMaster Universities Arthritis Index and Kellgren and Lawrence grades show strong potential for use in future prognostic model development. Measurements of general mental health and obesity were not prognostic for nonresponse.

Keywords: arthroplasty; function; knee; nomogram; pain; prognosis.

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Figures

None
Calibration curve analysis with unicompartmental KAs removed from the dataset and using Model #1.
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Calibration curve analysis with unicompartmental KAs removed from the dataset and using Model #2.
Figure 1
Figure 1
The external validation curve is illustrated. The observed probability of nonresponse is presented on the y-axis and the regression-predicted probability of non-response is presented on the x-axis. The diagonal line indicates perfect agreement between the observed and predicted probability of nonresponse.
Figure 2
Figure 2
The OAI data were used to generate the calibration curve. The observed probability of nonresponse is presented on the y-axis and the regression-predicted probability of non-response is presented on the x-axis. The diagonal line indicates perfect agreement between the observed and predicted probability of nonresponse. Deviation from perfect agreement occurs at beginning, middle and end of the curve.
Figure 3
Figure 3
The preoperative WOMAC Total scores from the OAI data were used to generate the calibration curve. The observed probability of nonresponse is presented on the y-axis and the regression-predicted probability of non-response is presented on the x-axis. The diagonal line indicates perfect agreement between the observed and predicted probability of nonresponse. A more substantial deviation from perfect agreement as compared to Figure 2.
See this image and copyright information in PMC

References

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