1. Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome
- Author
-
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, and Bukky Dada
- Subjects
Medicine - Abstract
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.
- Published
- 2023
- Full Text
- View/download PDF