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How often is the office visit needed? Predicting total knee arthroplasty revision risk using pain/function scores
Charles D Hightower1, Lisa S Hightower2, Penny J Tatman3
1Alaska Native Medical Center, Anchorage, AK, USA.
BMC Health Services Research
|August 25, 2016
Summary
Pain and function scores after total knee arthroplasty (TKA) can predict revision surgery. A 15-month follow-up using American Knee Society (AKS) scores can identify patients unlikely to need revision with 99% accuracy.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Primary total knee arthroplasty (TKA) outcomes are generally favorable, but reliable methods to predict poor outcomes are lacking.
- Routine annual clinic visits for well-functioning TKAs aim to detect early failure, but the utility of pain and function assessments for predicting revision is unknown.
Purpose of the Study:
- To determine if pain and function assessments can predict the need for revision surgery after primary TKA.
- To identify predictive factors for revision surgery in TKA patients.
Main Methods:
- Retrospective analysis of a large, prospectively gathered TKA registry.
- Comparison of outcome score changes in TKAs undergoing revision versus those not requiring revision.
Main Results:
- Significant predictors of revision surgery included preoperative, 3-month, and 15-month postoperative American Knee Society (AKS) Clinical Scores, and 3-month AKS Function Scores.
- Patients with low predicted revision probability (≤32%) at 15 months had a 99% negative predictive value for requiring revision surgery.
- Non-revised patients had higher AKS Clinical and Function Scores than revision patients, with acute revisions having higher scores than latent revisions.
Conclusions:
- Time-dependent evaluation of AKS outcome scores at 15 months post-TKA can risk-stratify patients for revision surgery.
- Replication with patient-reported outcome measures could enable virtual follow-ups, potentially replacing clinic visits for well-performing patients.
