Risk factors for delayed inpatient functional recovery after total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine
• Biostatistics

Background:

• Delayed functional recovery after total knee arthroplasty (TKA) impacts patient outcomes and healthcare resource utilization.
• Identifying predictors of delayed recovery is crucial for optimizing patient care and rehabilitation strategies.

Purpose of the Study:

• To assess the predictive value of surgery-related variables for delayed inpatient functional recovery (defined as ≥3 days to achieve functional independence) following TKA.
• To evaluate the contribution of surgical factors in conjunction with patient characteristics to predict delayed recovery.

Main Methods:

• A prospective cohort study involving 193 patients undergoing TKA.
• Inpatient functional recovery was monitored daily using the Iowa Level of Assistance scale (ILAS).
• Patient demographics (age, sex, BMI) and surgical variables (blood loss, tourniquet time, morphine use, surgical experience) were extracted and analyzed using logistic regression and AUC calculations.

Main Results:

• Delayed functional recovery was observed in 39% of patients.
• Higher age, female sex, and increased BMI were identified as independent risk factors for delayed recovery (AUC=0.72).
• Surgical experience significantly improved the predictive model (OR=0.31, AUC=0.76), while blood loss, tourniquet time, and postoperative morphine use did not significantly enhance prediction.

Conclusions:

• Patient-related factors, particularly age, sex, and BMI, are stronger predictors of delayed functional recovery after TKA than most surgery-related variables.
• Surgical experience demonstrates predictive value, suggesting its importance in optimizing patient outcomes.
• The findings underscore the need to consider patient characteristics prominently in predicting and managing functional recovery post-TKA.