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Variability in long-term pain and function trajectories after total knee replacement: A cohort study.

Vikki Wylde1, Chris Penfold1, Alice Rose2

  • 1Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|October 10, 2019
PubMed
Summary

Patient outcomes after total knee replacement (TKR) vary significantly long-term. Many patients experience continued improvement or worsening of pain and function beyond the first year, highlighting the need for realistic expectations post-TKR.

Keywords:
FunctionPROMSPainTotal knee replacementTrajectories

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Area of Science:

  • Orthopaedic Surgery
  • Biomedical Engineering
  • Rehabilitation Medicine

Background:

  • Patient-reported outcomes after total knee replacement (TKR) are often assumed to plateau by one year.
  • Previous analyses have focused on average changes, potentially masking long-term outcome variability.

Purpose of the Study:

  • To investigate the variability in long-term pain and function trajectories following total knee replacement (TKR).

Main Methods:

  • A prospective cohort study of 266 patients undergoing Triathlon® TKR for osteoarthritis.
  • Pain and function were assessed using WOMAC scales preoperatively and up to 7 years post-operatively.
  • Longitudinal analyses identified patterns of clinically meaningful change.

Main Results:

  • Most patients improved in pain and function within the first year, with greatest gains in the first 3 months.
  • By 1 year, 8% had no pain improvement and 21% had no function improvement.
  • Between subsequent annual assessments, approximately 15% of patients improved and 15% worsened; one-third of those with no change at 1 year improved by year 2.

Conclusions:

  • Significant and clinically meaningful variability exists in long-term pain and function after TKR.
  • Communicating these diverse trajectories can help manage patient expectations.
  • Further research should explore factors influencing outcome variability and identify patients at risk for poor results.