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Early Aseptic Revisions After Total Knee Arthroplasty Have a Negative Impact on Patient-Reported Outcomes
Jesus M Villa1, Vivek Singh1, Matan Ozery1
1Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
Background:
Evidence on the effects of time to failure from primary total knee arthroplasty (TKA) to the first aseptic revision TKA (rTKA) on clinical and patient-reported outcome measures (PROMs) is lacking. Thus, we sought to compare demographics, operative time, length of stay, discharge disposition, 90-days readmissions, re-revision rates, mortality, and PROMs between early and late aseptic rTKAs.
Methods:
This is a retrospective chart review study of all elective aseptic rTKA procedures performed at a single institution from August 2015 to December 2018, 708 patients were analyzed. Patients were categorized into either early rTKA (< three years; n = 238) or late rTKA (≥ three years; n = 470) cohorts. Variables of interest compared between both groups included demographics, surgical and inpatient characteristics, clinical results, as well as PROMs at baseline and 1-year of follow-up, delta changes (1-year minus baseline), and proportion of patients achieving minimal clinically important differences (MCID) improvements (1-year minus baseline).
Results:
Demographics were not significantly different, except for age and indications for the first aseptic rTKA. Delta changes for knee injury and osteoarthritis outcome score (KOOS), quality of life (QoL) (18.8 versus 31.2; P = 0.009), and veterans RAND-12 (VR-12) physical component (6.4 versus 9.7; P = 0.035) scores were significantly lower for the early aseptic rTKA cohort. These patients also reported significantly higher pain, lower physical function, quality of life, and general physical and mental health status at one year of follow-up. For KOOS pain and quality of life, significantly more patients in the late aseptic rTKA group achieved MCID improvements (from baseline to one year of follow-up).
Conclusions:
Patients undergoing early aseptic rTKA report experiencing more postoperative pain, worse quality of life, and lower physical and mental functionality. Time to failure should be taken into account when assessing PROMs, setting expectations, and counseling patients.
Level Iii Evidence:
Retrospective cohort study.
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