RMD Open (Apr 2023)

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

  • ,
  • Gillian A Hawker,
  • Eric Bohm,
  • James Stewart,
  • Deborah A Marshall,
  • Raj Sharma,
  • Jason Werle,
  • Peter Faris,
  • Linda J Woodhouse,
  • Bheeshma Ravi,
  • Paul Duffy,
  • Shannon Puloski,
  • Kelly Johnston,
  • Greg Abelseth,
  • Raul Kuchinad,
  • Tom Noseworthy,
  • John Donaghy,
  • C Allyson Jones,
  • James Powell,
  • Ian Stanaitis,
  • Michael J Dunbar,
  • Gillian A. Hawker,
  • Deborah A. Marshall,
  • Michael J. Dunbar,
  • C. Allyson Jones,
  • Linda J. Woodhouse,
  • Gordon Arnett,
  • Robert Balyk,
  • Jeffery Bury,
  • John Cinats,
  • Donald Dick,
  • D'Arcy Durand,
  • Lee Ekert,
  • Robert Glasgow,
  • Don Glasgow,
  • Gordon Goplen,
  • Catherine Hui,
  • Ben Herman,
  • Larry Hunka,
  • Hongxing Jiang,
  • William C. Johnson,
  • Frank Kortbeek,
  • Guy Lavoie,
  • Mitch Lavoie,
  • Paul K. Leung,
  • James Mahood,
  • Edward Masson,
  • Richard McLeod,
  • James McMillan,
  • Greg O’Connor,
  • David Otto,
  • Carlo Panaro,
  • Paulose Paul,
  • Gordon Russell,
  • Colleen Weeks,
  • Don Weber,
  • Andrea Woo,
  • Jane Squire Howden,
  • Anne-Marie Adachi,
  • Jessica Beatty,
  • Shakib Rahman,
  • Kelley De Souza,
  • Robert Korley,
  • Michael Monument,
  • Maureen O'Brien,
  • Ed Rendall,
  • Alex Rezansoff,
  • Scott Timmerman,
  • Tanya Reczek,
  • Jeffrey Depew,
  • Bukky Dada

DOI
https://doi.org/10.1136/rmdopen-2022-002808
Journal volume & issue
Vol. 9, no. 2

Abstract

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Objectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.Methods In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.Results Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.Conclusions Although external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.