Influencing Factors on the Quality of Recovery After Total Knee Arthroplasty: Development of a Predictive Model

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Sep 13

PMID 39267965

Authors

Sen Shan

Qingpeng Shi

Hengyuan Zhang

Affiliations

Soon will be listed here.

Abstract

Introduction: Total Knee Arthroplasty (TKA) is a widely performed procedure that significantly benefits patients with severe knee degeneration. However, the recovery outcomes post-surgery can vary significantly among patients. Identifying the factors influencing these outcomes is crucial for improving patient care and satisfaction.

Methods: In this retrospective study, we analyzed 362 TKA cases performed between January 1, 2018, and July 1, 2022. Multivariate logistic regression was employed to identify key predictors of recovery within the first year after surgery.

Results: The analysis revealed that Body Mass Index (BMI), age-adjusted Charlson Comorbidity Index (aCCI), sleep quality, Bone Mineral Density (BMD), and analgesic efficacy were significant predictors of poor recovery ( < 0.05). These predictors were used to develop a clinical prediction model, which demonstrated strong predictive ability with an Area Under the Receiver Operating Characteristic (AUC) curve of 0.802. The model was internally validated.

Discussion: The findings suggest that personalized postoperative care and tailored rehabilitation programs based on these predictors could enhance recovery outcomes and increase patient satisfaction following TKA.

References

Viscusi E . Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med. 2008; 33(2):146-58. DOI: 10.1016/j.rapm.2007.11.005. View

Liow R, Walker K, Wajid M, Bedi G, Lennox C . The reliability of the American Knee Society Score. Acta Orthop Scand. 2001; 71(6):603-8. DOI: 10.1080/000164700317362244 . View

Krych A, Horlocker T, Hebl J, Pagnano M . Contemporary pain management strategies for minimally invasive total knee arthroplasty. Instr Course Lect. 2010; 59:99-109. View

Lavandhomme P, Kehlet H, Rawal N, Joshi G . Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J Anaesthesiol. 2022; 39(9):743-757. PMC: 9891300. DOI: 10.1097/EJA.0000000000001691. View

Sweerts L, Hoogeboom T, van Wessel T, van der Wees P, van de Groes S . Development of prediction models for complications after primary total hip and knee arthroplasty: a single-centre retrospective cohort study in the Netherlands. BMJ Open. 2022; 12(8):e062065. PMC: 9413190. DOI: 10.1136/bmjopen-2022-062065. View

Hylkema T, Brouwer S, Stewart R, Beveren J, Rijk P, Brouwer R . Two-year recovery courses of physical and mental impairments, activity limitations, and participation restrictions after total knee arthroplasty among working-age patients. Disabil Rehabil. 2020; 44(2):291-300. DOI: 10.1080/09638288.2020.1766583. View

Kanis J, McCloskey E, Johansson H, Oden A, Melton 3rd L, Khaltaev N . A reference standard for the description of osteoporosis. Bone. 2008; 42(3):467-75. DOI: 10.1016/j.bone.2007.11.001. View

Namba R, Singh A, Paxton E, Inacio M . Patient Factors Associated With Prolonged Postoperative Opioid Use After Total Knee Arthroplasty. J Arthroplasty. 2018; 33(8):2449-2454. DOI: 10.1016/j.arth.2018.03.068. View

Kraus V, Blanco F, Englund M, Karsdal M, Lohmander L . Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage. 2015; 23(8):1233-41. PMC: 4516635. DOI: 10.1016/j.joca.2015.03.036. View

10.

Mohammad H, Kennedy J, Mellon S, Judge A, Dodd C, Murray D . The clinical outcomes of cementless unicompartmental knee replacement in patients with reduced bone mineral density. J Orthop Surg Res. 2020; 15(1):35. PMC: 6995049. DOI: 10.1186/s13018-020-1566-2. View

11.

Correa-Valderrama A, Stangl-Herrera W, Echeverry-Velez A, Cantor E, Ron-Translateur T, Palacio-Villegas J . Relationship between Body Mass Index and Complications during the First 45 Days after Primary Total Hip and Knee Replacement: A Single-Center Study from South America. Clin Orthop Surg. 2019; 11(2):159-163. PMC: 6526130. DOI: 10.4055/cios.2019.11.2.159. View

12.

Pavlovic N, Harris I, Boland R, Brady B, Genel F, Naylor J . The effect of body mass index and preoperative weight loss in people with obesity on postoperative outcomes to 6 months following total hip or knee arthroplasty: a retrospective study. Arthroplasty. 2023; 5(1):48. PMC: 10544191. DOI: 10.1186/s42836-023-00203-5. View

13.

Rampes S, Ma K, Divecha Y, Alam A, Ma D . Postoperative sleep disorders and their potential impacts on surgical outcomes. J Biomed Res. 2020; 34(4):271-280. PMC: 7386412. DOI: 10.7555/JBR.33.20190054. View

14.

Asif S, Choon D . Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005; 13(3):280-4. DOI: 10.1177/230949900501300311. View

15.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

16.

Futier E, Lefrant J, Guinot P, Godet T, Lorne E, Cuvillon P . Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2017; 318(14):1346-1357. PMC: 5710560. DOI: 10.1001/jama.2017.14172. View

17.

Shim J, McLernon D, Hamilton D, Simpson H, Beasley M, Macfarlane G . Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study. Rheumatol Adv Pract. 2018; 2(2):rky021. PMC: 6251482. DOI: 10.1093/rap/rky021. View

18.

Wylde V, Penfold C, Rose A, Blom A . Variability in long-term pain and function trajectories after total knee replacement: A cohort study. Orthop Traumatol Surg Res. 2019; 105(7):1345-1350. DOI: 10.1016/j.otsr.2019.08.014. View

19.

Vissers M, Bussmann J, de Groot I, Verhaar J, Reijman M . Physical functioning four years after total hip and knee arthroplasty. Gait Posture. 2013; 38(2):310-5. DOI: 10.1016/j.gaitpost.2012.12.007. View

20.

Ha C, Park Y . Underestimation and undertreatment of osteoporosis in patients awaiting primary total knee arthroplasty. Arch Orthop Trauma Surg. 2020; 140(8):1109-1114. DOI: 10.1007/s00402-020-03462-y. View