Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty

Orr, Melissa N.; Klika, Alison K.; Piuzzi, Nicolás S.; Higuera-Rueda, Carlos A.; Barsoum, Wael K.; Molloy, Robert; Murray, Trevor G.; Krebs, Viktor E.; Patel, Preetesh D.; Stearns, Kim L.; Greene, Kenneth; Bloomfield, Michael R.; Nickodem, Robert J.; Mesko, Nathan W.; Schaffer, Jonathan; Hampton, Robert

doi:10.1016/j.arth.2022.02.090

Cited by 41 publications

(42 citation statements)

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“…While patients may undergo TKA for different reasons and surgical decision-making is made on an individual case-by-case basis, orthopaedic surgeons should be cognizant of the racial differences noted in the present study considering lower baseline pain and functional levels have been associated with increased dissatisfaction post-TKA. 30 We acknowledge that we observed variability in PROMs from quarter to quarter and 20 or more years of data may be preferred to determine true trends in arthroplasty. However, the current study utilized the most extensive institutional cohort to date to investigate preoperative baseline pain and function trends.…”

Section: Discussionmentioning

confidence: 84%

When Do We Perform Elective Total Knee Arthroplasty? General and Demographic-Specific Trends of Preoperative Pain and Function among 10,327 Patients

et al. 2022

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Total knee arthroplasty (TKA) is the sole disease-modifying intervention for end-stage osteoarthritis. However, the temporal trends and stratification of age and patient demographics of pain and function levels at which surgeons perform TKA have not been characterized. The present investigation aimed to analyze the temporal trends of preoperative pain and functional patient-reported outcomes measures (PROMs) over the past 5 years when stratifying patient demographics. A prospective cohort of all patients who underwent primary elective TKA between January 2016 and December 2020 at a North American integrated tertiary health care system was retrospectively reviewed. The primary outcome was quarterly baseline (preoperative) pain and function PROM values before primary elective TKA. Evaluated PROMs included Knee Osteoarthritis Outcome Score (KOOS)-pain and KOOS-physical function shortform (PS) for the 5-year study period and were stratified by patient demographics (age, sex, race, and body mass index [BMI]). A total of 10,327 patients were analyzed. Preoperative pain levels remained unchanged over the study period for patients in the 45- to 64-year category (P-trend = 0.922). Conversely, there was a significant improvement in preoperative pain levels in the 65+ years group. Sex-stratified trends between males and females did not demonstrate a significant change in pre-TKA baseline pain over the study period (P-trend = 0.347 and P-trend = 0.0744). Both white and black patients demonstrated consistent KOOS-pain levels throughout the study period (P-trend = 0.0855 and P-trend = 0.626). Only white patients demonstrated improving preoperative KOOS-PS (P-trend = 0.0001), while black and “other” patients demonstrated consistent lower preoperative functional levels throughout the study period (P-trend = 0.456 and P-trend = 0.871). All BMI categories demonstrated relatively consistent preoperative KOOS-pain and KOOS-PS except for overweight and obese patients who demonstrated progressive improvement in preoperative KOOS-PS over the study period. Patients and surgeons are electing to perform primary TKA at higher levels of preoperative function. Stratification by race showed black patients did not experience a similar trend of improving function and exhibited a consistently lower functional level versus white patients. This disparity is likely to be multifactorial but may indicate underlying barriers to TKA access.

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Section: Discussionmentioning

confidence: 84%

When Do We Perform Elective Total Knee Arthroplasty? General and Demographic-Specific Trends of Preoperative Pain and Function among 10,327 Patients

et al. 2022

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“…Addressing mental health is an important aspect of the management of orthopaedic patients. Patients with suboptimal mental health have worse postoperative outcomes, reduced patient satisfaction, and greater episode-of-care costs after orthopaedic surgery 1-7,9,10,27 . Therefore, optimization of mental and physical health has the potential to improve functional outcomes and mitigate complications.…”

Section: Discussionmentioning

confidence: 99%

“…There is a well-described association between mental health deficits and suboptimal postoperative outcomes, reduced patient satisfaction, higher complication rates, and greater episode-of-care costs after orthopaedic surgery 1-7,9,10,27 . In addition, there is a complimentary body of evidence indicating that psychosocial interventions such as resilience training can reduce pain catastrophizing, lower disability, and improve physical functioning after orthopaedic surgery 28-30 .…”

Section: Preoperative Screening and Patient Optimizationmentioning

confidence: 99%

“…Patients endorsing mental health symptoms may experience impaired motivation, reduced participation in rehabilitation, and catastrophizing behaviors that contribute to poor outcomes after surgery 4,7 . For example, preoperative mental health symptoms or interference have been associated with reduced functional improvement and patient satisfaction as measured by a variety of patient-reported outcome measures, as well as increased postoperative complications, pain, and opioid use 1,2,10-12 . Psychological comorbidities have also been associated with increased readmission rates, reoperation, length of stay, total surgical episode costs, and non–home discharge rates 2,4 .…”

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Team Approach: Management of Mental Health in Orthopaedic Patients

et al. 2023

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Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist.» The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures.» Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A891).

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“…1 2 The improvements in pain relief, functional outcomes, mobility, and independence afforded by TKA generally outweigh its inherent risks. 3 Consequently, the popularity of joint replacement in the United States (USA) has exhibited steady growth within the last two decades. In 2014 680150 primary TKAs were performed which represented a 148% growth since the year 2000 (274025 performed) with conservative figures projecting an increase to 93500 procedures annually by 2030.…”

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confidence: 99%

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

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Background Mortality data following primary total knee arthroplasty (TKA) beyond the 1-year postoperative time period is sparse. This systematic review and meta-analysis aimed to: 1) estimate contemporary mortality rates at 30-days, 90-days, 1-year, 5-years, and 10-years following primary TKA; and 2) identify risk factors and causes of mortality following TKA. Methods PubMed, MEDLINE, Cochrane, EBSCO host, and Google Scholar databases were queried from January 1, 2011 to October 30, 2021 for all studies reporting mortality rates following primary TKA. A meta-analysis of proportions was conducted using a random-effects model to ascertain pooled mortality rates (95% confidence interval [CI]). Meta-regression was utilized to account for confounding effects on mortality rates due to the study’s country of origin, median date of study data, average patient age, and patient gender ratios, with a level of significance maintained at P-value <0.05. Results A total of 44 articles were included in quantitative synthesis. The pooled 30-day mortality rate was 0.14%(95% CI:0.05%-0.22%; n=1,817,647). The pooled 90-day mortality rate was 0.35%(95% CI:0.0.28%-0.43%; n=1,641,974). The pooled 1-year mortality was 1.1%(95% CI:0.71%-1.49%; n=1,178,698). The pooled 5-year mortality rate was 5.38%(95% CI:4.35%-6.42%; n=597,041). The pooled 10-year mortality rate was 10.18%(95% CI:7.78 %-12.64 %; n=815,901). Our 30-day mortality rate was lower than previously reported. The most common causes of death at all time points were due to cardiac disease, cerebrovascular disease, and malignancy. Obesity demonstrated mixed effects on long term mortality rates. Conclusion Overall mortality rates of TKA remain low worldwide at all time points and immediate postoperative mortality rates continue to fall. Compared to symptomatic knee osteoarthritic patients reported in the literature, TKA patients qualitatively exhibited lower mortality rates, which may support the value of TKA in improving quality of life without associated excess mortality. Future long-term mortality studies should be conducted to account for geographical variability in mortality rates and further elucidate modifiable risk factors associated with mortality among TKA patients.

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Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty

Cited by 41 publications

References 50 publications

When Do We Perform Elective Total Knee Arthroplasty? General and Demographic-Specific Trends of Preoperative Pain and Function among 10,327 Patients

When Do We Perform Elective Total Knee Arthroplasty? General and Demographic-Specific Trends of Preoperative Pain and Function among 10,327 Patients

Team Approach: Management of Mental Health in Orthopaedic Patients

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

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