Incorporation of Patients’ TKA Readiness, Expectations Predict Postsurgical Outcomes

Favorable postsurgical outcomes may be observed when patients’ expectations and willingness/readiness prior to total knee arthroplasty (TKA) are considered, according to study results published in RMD Open.

Researchers aimed to evaluate the effect of patient readiness/willingness and expectations on the ability to distinguish between those who would vs would not have good post-TKA outcomes.

A prospective cohort study was conducted among patients with osteoarthritis (OA) who were referred for TKA surgery from 2 orthopedic clinics in Alberta, Canada, from 2014 to 2016. Inclusion criteria included confirmation of OA by physical examination or imaging, age 30 years and older, and ability to read and comprehend English

Primary study outcomes were a meaningful improvement of OA symptoms and patient-reported satisfaction with TKA results.

Knee pain and level of disability were assessed using the Western Ontario-McMaster Universities OA Index (WOMAC) and as Knee Injury and Osteoarthritis Outcome Score physical function short-form (KOOS-PS).

Patients’ ability to cope with knee symptoms was validated using the 4-item Arthritis Coping Efficacy Scale, as well as reviewing previous OA therapies (medications, physiotherapy, and formal or informal exercise). Questionnaires to assess psychologic readiness, as well as TKA expectations, were also developed and distributed among participants.

Researchers conducted a reassessment of knee symptoms at 1 year postsurgery to understand changes in knee pain and function, as well as overall satisfaction.

A total of 1275 patients underwent TKA and completed the 1-year follow-up assessment, and data from 1053 were included in the analysis. 

Multivariate models indicated that a good TKA outcome was significantly higher in those with a greater TKA need (adjusted RR per 10-unit increase WOMAC Pain Score: 1.03; 95% CI, 1.01-1.05; adjusted RR per 10-unit increase KOOS-PS: 1.06; 95% CI, 1.03-1.08), as well as those who considered it “very important” that TKA improve the ability to go upstairs and perform recreational activities (adjusted RR and 95% CI, 1.15, 1.02-1.30 and 1.10, 1.01-1.20, respectively). Those who considered it “very important” that TKA improve their ability to kneel or psychologic well-being had a significantly lower probability of achieving a good outcome (adjusted RR and 95% CI, 0.93, 0.87-0.99 and 0.92; 0.86-0.99, respectively).

The need for TKA was defined by tertiles of WOMAC Pain Score and KOOS-PS, which was considered “high” if both were in the uppermost tertiles (WOMAC Pain Score ≥60 and KOOS-PS ≥62), “low” if both were in the lowest tertiles (WOMAC Pain Score ≤45 and KOOS-PS ≤44), and “moderate” otherwise.

Expectations for TKA positively associated with outcome (improved ability to go upstairs and perform recreational activities) were considered “realistic,” and those negatively associated with outcome (improved ability to kneel or improved psychological well-being) were considered “unrealistic.”

The probability of a good TKA outcome was lower (33.9%-55.5%) in those with a low TKA need with unrealistic expectations compared with those with a high TKA need with realistic expectations (88.4%-95.1%).

One of the main study limitations included the lack of generalizability, as the study was primarily conducted in Alberta, Canada.

The study authors noted, “These findings highlight the need for explicit incorporation of patients’ preferences and values in assessment of TKA appropriateness and suggest that doing so has the potential to improve the proportion of TKA recipients who experience a good surgical outcome.”