Attainment of Substantial Clinical Benefit Following Primary Total Knee Arthroplasty Is Impacted by Preoperative...

The Centers for Medicare & Medicaid Services (CMS) has made the collection of patient-reported outcome measures (PROMs) mandatory for inpatient total knee arthroplasty (TKA). The reporting of the proportion of patients who reach the substantial clinical benefit (SCB) threshold between preoperative and postoperative PROMs based on Knee Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores is also necessary for reimbursement. Our study evaluated characteristics among patients who did and did not meet SCB to understand trends that may help surgeons to comply with CMS policies and maximize patient outcomes following TKA.

A retrospective review was performed of patients undergoing primary TKA between January 2021 and August 2024 at a single large academic center. Demographic, operative, and outcome variables were compared between patients who met SCB and those who did not. Multivariable analysis was performed to identify risk factors for failure to achieve SCB. A total of 807 of 3,538 patients (23%) were eligible for inclusion based on completion of both preoperative and postoperative KOOS JR surveys; 62% of whom reached SCB.

There were few differences in demographics and no significant differences in complications between subgroups. Patients had strikingly different PROM profiles; the group failing to meet SCB reported less pain and higher function preoperatively and more pain, lower function, and lower satisfaction postoperatively in comparison to patients meeting SCB. Patients who had a preoperative KOOS JR interval score > 53.65 were 5.01 times more likely not to achieve SCB (95% confidence interval 3.63 to 6.98; q < 0.001).

Our results demonstrate the difficulty of collecting PROMs in accordance with the CMS mandate and point to distinct differences in PROM profiles related to SCB achievement. Attaining SCB following TKA is a metric of patient satisfaction, and these findings can help guide patient expectations.