Stratified Recovery Curves for Patient-Reported Outcomes After Primary Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine
• Health Services Research

Background:

• Limited literature exists on how patient demographics and modifiable factors influence recovery after total knee arthroplasty (TKA).
• Patient-reported outcomes (PROs) are crucial for assessing TKA success.
• Understanding recovery trajectories is vital for effective perioperative counseling.

Purpose of the Study:

• To assess the influence of patient demographics and modifiable factors on PRO recovery curves after primary TKA.
• To develop visual aids for perioperative counseling based on identified recovery patterns.

Main Methods:

• Analysis of prospective multicenter data from 2196 primary TKA patients.
• Longitudinal modeling of Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores using generalized estimating equations.
• Inclusion of interaction terms to assess differences in recovery trajectories based on age, sex, race, ethnicity, BMI, smoking, opioid use, and activity level.

Main Results:

• Younger (<50 years), female, black, Hispanic, underweight, and pre-op opioid users reported lower KOOS JR scores post-TKA.
• Women showed a significantly faster recovery rate.
• Black and Hispanic patients showed similar recovery rates to white and non-Hispanic patients, respectively.
• Pre-op opioid users had quicker initial recovery (3 months) but similar long-term rates.

Conclusions:

• Patient demographics and modifiable factors significantly impact recovery following primary TKA.
• These findings can inform and improve patient counseling regarding TKA recovery expectations.
• Visual aids derived from these recovery curves can enhance patient understanding and management.