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Heart failure patients demonstrate excellent 1-year outcomes after total knee arthroplasty despite high healthcare

Nickelas Huffman1, Abizairie Sánchez-Feliciano2, Khaled A Elmenawi1

  • 1Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|October 9, 2025
PubMed

Insights

Heart failure patients undergoing total knee arthroplasty (TKA) experience higher healthcare use but achieve similar pain and function improvements as non-heart failure patients. Heart failure severity does not impact these outcomes, suggesting tailored risk stratification may not be needed.

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Health Services Research

Background:

  • Total knee arthroplasty (TKA) is frequently performed in patients with heart failure (HF).
  • Postoperative outcomes and healthcare resource utilization in these patients are not well-defined.
  • Understanding these outcomes is crucial for optimizing perioperative care.

Purpose of the Study:

  • To compare healthcare resource utilization and patient-reported outcome measures (PROMs) after TKA between patients with and without HF.
  • To analyze outcomes based on HF severity, specifically ejection fraction (EF) categories.

Main Methods:

  • Retrospective analysis of 12,491 TKA patients (2016-2021), including 495 with HF.
  • HF patients categorized by EF: preserved (≥50%), mildly reduced (41-49%), and reduced (≤40%).
  • Comparison of healthcare utilization metrics, 1-year mortality, and PROMs (KOOS-Pain, KOOS-PS, KOOS-JR) using MCID and PASS thresholds.

Main Results:

  • HF patients showed significantly higher odds of prolonged hospital stay, non-home discharge, 90-day readmission, 90-day ED visits, and 1-year mortality.
  • One-year PROMs were similar between HF and non-HF groups; HF patients were more likely to achieve MCID for KOOS-PS.
  • Mildly reduced EF subgroup reported higher 1-year KOOS-Pain and achieved PASS for pain; EF did not predict 1-year outcomes.

Conclusions:

  • Despite increased healthcare utilization, HF patients achieve comparable functional and pain improvements after TKA.
  • HF severity (EF) did not correlate with differential healthcare utilization or outcomes, questioning the need for HF-specific risk stratification.
  • Further research may explore specific interventions to mitigate increased resource use in HF patients undergoing TKA.
Abstract

Keywords:
Heart failureKnee disability and osteoarthritis outcome scorePatient-reported outcome measuresTotal knee arthroplasty

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