Patients Consistently Report Worse Outcomes Following Revision Total Knee Arthroplasty Compared to Primary Total Knee Arthroplasty

Mehdi S Salimy; Aris Paschalidis; Jacquelyn A Dunahoe; MGB Arthroplasty Patient-Reported Outcomes Writing Committee; Hany S Bedair; Christopher M Melnic

doi:10.1016/j.arth.2023.08.014

Patients Consistently Report Worse Outcomes Following Revision Total Knee Arthroplasty Compared to Primary Total Knee Arthroplasty

J Arthroplasty. 2024 Feb;39(2):459-465.e1. doi: 10.1016/j.arth.2023.08.014. Epub 2023 Aug 11.

Authors

Mehdi S Salimy¹, Aris Paschalidis¹, Jacquelyn A Dunahoe¹; MGB Arthroplasty Patient-Reported Outcomes Writing Committee; Hany S Bedair², Christopher M Melnic²

Collaborators

MGB Arthroplasty Patient-Reported Outcomes Writing Committee:
Antonia F Chen, Kyle Alpaugh

Affiliations

¹ Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
² Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.

PMID: 37572718
DOI: 10.1016/j.arth.2023.08.014

Abstract

Background: Differences in patient-reported outcome measures (PROMs) between primary TKA (pTKA) and revision TKA (rTKA) have not been well-studied. Therefore, we compared pTKA and rTKA patients by the rates of achieving the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W).

Methods: A total of 2,448 patients (2,239 pTKAs/209 rTKAs) were retrospectively studied. Patients who completed the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, or PROMIS Global-Physical questionnaires were identified by Current Procedural Terminology (CPT) codes. Patient-reported outcome measures and MCID-I/MCID-W rates were compared. Multivariate logistic regression models measured relationships between surgery type and postoperative outcomes.

Results: Patients who underwent rTKA (all causes) had lower rates of improvement and higher rates of worsening compared to pTKA patients for KOOS-PS (MCID-I: 54 versus 68%, P < .001; MCID-W: 18 versus 8.6%, P < .001), PF10a (MCID-I: 44 versus 65%, P < .001; MCID-W: 22 versus 11%, P < .001), PROMIS Global-Mental (MCID-I: 34 versus 45%, P = .005), and PROMIS Global-Physical (MCID-I: 51 versus 60%, P = .014; MCID-W: 29 versus 14%, P < .001). Undergoing revision was predictive of worsening postoperatively for KOOS-PS, PF10a, and PROMIS Global-Physical compared to pTKA. Postoperative scores were significantly higher for all 4 PROMs following pTKA.

Conclusion: Patients reported significantly less improvement and higher rates of worsening following rTKA, particularly for PROMs that assessed physical function. Although pTKA patients did better overall, the improvement rates may be considered relatively low and should prompt discussions on improving outcomes following pTKA and rTKA.

Level of evidence: Level III, retrospective comparative study.

Keywords: MCID; PROMs; primary total knee arthroplasty; revision total knee arthroplasty; total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee*
Humans
Osteoarthritis, Knee* / surgery
Patient Reported Outcome Measures
Retrospective Studies
Treatment Outcome