Predictive Models for Clinical Outcomes in Total Knee Arthroplasty: A Systematic Analysis

Abstract

Background: Predictive modeling promises to improve our understanding of what variables influence patient satisfaction after total knee arthroplasty (TKA). The purpose of this article was to systematically review the relevant literature using predictive models of clinical outcomes after TKA. The aim was to identify the predictor strategies used for systematic data collection with the highest likelihood of success in predicting clinical outcomes. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review was conducted using 3 databases (MEDLINE, EMBASE, and PubMed) to identify all clinical studies that had used predictive models or that assessed predictive features for outcomes after TKA between 1996 and 2020. The ROBINS-I tool was used to evaluate the quality of the studies and the risk of bias. Results: A total of 75 studies were identified of which 48 met our inclusion criteria. Preoperative predictive factors strongly associated with postoperative clinical outcomes were knee pain, knee-specific Patient-Reported Outcome Measure (PROM) scores, and mental health scores. Demographic characteristics, pre-existing comorbidities, and knee alignment had an inconsistent association with outcomes. The outcome measures that correlated best with the predictive models were improvement of PROM scores, pain scores, and patient satisfaction. Conclusions: Several algorithms, based on PROM improvement, patient satisfaction, or pain after TKA, have been developed to improve decision-making regarding both indications for surgery and surgical strategy. Functional features such as preoperative pain and PROM scores were highly predictive for clinical outcomes after TKA. Some variables such as demographics data or knee alignment were less strongly correlated with TKA outcomes. Level of evidence: Systematic review e Level III.

Prehabilitation for Patients Undergoing Orthopedic Surgery

“…Numerous factors such as preoperative muscle strength, function, and HRQOL are predictive factors associated with postoperative function in the population undergoing orthopedic surgery. [5][6][7][8] Poor fitness and deconditioning could negatively influence postoperative outcomes. 101 Additionally, postponement of elective operations due to the pandemic have led to increased waiting times, poorer access to support services, and heightened anxiety leading to further chronicity of symptoms and deconditioning of the patients.…”

“…Numerous factors such as preoperative muscle strength, function, and HRQOL are predictive factors associated with postoperative function in the population undergoing orthopedic surgery . Poor fitness and deconditioning could negatively influence postoperative outcomes .…”

“…4 Waiting for a surgical procedure therefore provides a window of opportunity to optimize and influence the preoperative muscle strength, function, and health-related quality of life (HRQOL) of a patient, which are often considered predictive factors associated with postoperative outcomes in the population undergoing orthopedic surgery. [5][6][7][8] This is termed prehabilitation. 9 Although prehabilitation has been reported in the literature since the 1940s, the role of prehabilitation in improving postoperative outcomes has only been researched from the year 2000.…”

“…Furthermore, undergoing a major surgical intervention can increase catabolism and oxygen demand, leading to a decline in one’s physical function . Waiting for a surgical procedure therefore provides a window of opportunity to optimize and influence the preoperative muscle strength, function, and health-related quality of life (HRQOL) of a patient, which are often considered predictive factors associated with postoperative outcomes in the population undergoing orthopedic surgery . This is termed prehabilitation …”

Evidence for key individual characteristics associated with outcomes following combined first-line interventions for knee osteoarthritis: A systematic review

“…Younger age was found to have a small association with becoming unwilling to undertake surgery following a multidisciplinary OA program [ 43 ]. The impact of increasing age on outcomes following TKR is also debated, with a 2021 systematic review concluding the evidence was inconsistent [ 72 ]. Our review suggests that age may not be a relevant factor in predicting response to first-line interventions for knee OA.…”