Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients

BMC Musculoskelet Disord. 2020 Jun 23;21(1):401. doi: 10.1186/s12891-020-03415-x.


Background: Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. Patient reported-outcome measures (PROMs) capture the patients' perception of the success of an intervention. The minimal important difference (MID) is an important characteristic of the PROM, which helps to interpret results. The aim of this study was to identify the MID for the Forgotten Joint Score-12 (FJS-12) and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.

Methods: Data were collected in a prospective cohort study. Patients were asked to complete the FJS-12, WOMAC osteoarthritis index and transition items evaluating change over time to determine the MID. We employed an anchor-based methodology relating score change to the response categories of the transition items using both binary logistic regression and receiver operating characteristic (ROC) analysis.

Results: Data from 199 patients were analysed. Mean age was 72.3 years, 58% were women. Employing binary logistic regression the MID for the FJS-12 was 10.8 points, for the WOMAC pain score 7.5 points and for the WOMAC function score 7.2 points. ROC analyses found a MID of 13.0 points for the FJS-12, 12.5 points for WOMAC pain and 14.7 points for WOMAC function.

Conclusion: We report MIDs for the FJS-12 and the WOMAC Pain and Function scales in a TKA patient cohort, which can be used to interpret meaningful differences in score. In line with previous research, we found more advanced statistical methods to result in smaller MID estimates for both scores.

Trial registration: Written consent for this study was obtained from all participants and ethical approval was granted by the local ethics committee (Ethikkommission St. Gallen; EKSG 14/973; Registered 03 July 2014;

Keywords: Forgotten Joint Score-12; Minimal important difference; Patient-reported outcomes; Total knee arthroplasty; WOMAC; Western Ontario and McMaster universities osteoarthritis index.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee*
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Prosthesis*
  • Knee Joint / physiopathology*
  • Logistic Models
  • Male
  • Middle Aged
  • Minimal Clinically Important Difference*
  • Osteoarthritis, Knee / surgery*
  • Prospective Studies
  • ROC Curve
  • Range of Motion, Articular
  • Severity of Illness Index
  • Switzerland
  • Treatment Outcome