Are Outcomes After TKA Worsening Over Time?
Total knee arthroplasty (TKA) is an extremely effective surgical treatment option for patients with end-stage refractory knee pain and associated functional disability. National Inpatient Sample (NIS) reported that 719,000 primary TKAs were performed in the U.S. in 2010, consistent with the projected estimates from a population-based study from the Olmsted County, Minnesota. The estimated cost per TKA is approximately US $24,200, leading to an annual cost burden of 17.6 billion for TKA in the U.S in 2010. TKA volume has increased dramatically in the last few decades and is projected to reach 3.5 million TKAs annually by 2030.
Many studies have focused on time-trends in utilization and specific in-hospital or immediate post-arthroplasty outcomes. To our knowledge, there are no studies assessing whether there are any appreciable time-trends in post-operative PROs, i.e., if the PROs after TKA have improved, worsened or remained stable over time. This is a critical knowledge gap since TKA is an elective surgery that results in an impressive improvement in patient-reported outcomes (PROs), including pain, function and quality of life in most patients. A small but sizable proportion of patients have suboptimal pain (7–13%) and function (21–27%) outcomes post-TKA. Even a 1% absolute increase means an additional 7,190 patients with suboptimal outcomes annually in the U.S. Socio-demographic and clinical characteristics of patients undergoing primary TKA cohort are changing rapidly with an increasing patient complexity over time in the U.S.. If there is an evolution in PRO outcomes post-arthroplasty over time, we need to know and understand that from a policy maker, clinician and patient perspective. Therefore, the objectives of this study were to: (1) examine the time trends in preoperative PROs of functional outcome and pain in patients undergoing primary TKA; (2) assess whether the risk of suboptimal PROs post-TKA has changed over time; (3) assess whether the risk of improving or worsening PROs post-TKA over time is independent of the preoperative PROs; and (4) study how these time-trends in post-TKA outcomes impact patients in different categories of age, medical and psychological comorbidity and body mass index (BMI). We hypothesized that post-TKA PROs would improve over time (hypothesis 1) and that most time-trends in improving PROs will be seen in the oldest, and in those with lower comorbidity and lower BMI (hypotheses 2–4).
Background
Total knee arthroplasty (TKA) is an extremely effective surgical treatment option for patients with end-stage refractory knee pain and associated functional disability. National Inpatient Sample (NIS) reported that 719,000 primary TKAs were performed in the U.S. in 2010, consistent with the projected estimates from a population-based study from the Olmsted County, Minnesota. The estimated cost per TKA is approximately US $24,200, leading to an annual cost burden of 17.6 billion for TKA in the U.S in 2010. TKA volume has increased dramatically in the last few decades and is projected to reach 3.5 million TKAs annually by 2030.
Many studies have focused on time-trends in utilization and specific in-hospital or immediate post-arthroplasty outcomes. To our knowledge, there are no studies assessing whether there are any appreciable time-trends in post-operative PROs, i.e., if the PROs after TKA have improved, worsened or remained stable over time. This is a critical knowledge gap since TKA is an elective surgery that results in an impressive improvement in patient-reported outcomes (PROs), including pain, function and quality of life in most patients. A small but sizable proportion of patients have suboptimal pain (7–13%) and function (21–27%) outcomes post-TKA. Even a 1% absolute increase means an additional 7,190 patients with suboptimal outcomes annually in the U.S. Socio-demographic and clinical characteristics of patients undergoing primary TKA cohort are changing rapidly with an increasing patient complexity over time in the U.S.. If there is an evolution in PRO outcomes post-arthroplasty over time, we need to know and understand that from a policy maker, clinician and patient perspective. Therefore, the objectives of this study were to: (1) examine the time trends in preoperative PROs of functional outcome and pain in patients undergoing primary TKA; (2) assess whether the risk of suboptimal PROs post-TKA has changed over time; (3) assess whether the risk of improving or worsening PROs post-TKA over time is independent of the preoperative PROs; and (4) study how these time-trends in post-TKA outcomes impact patients in different categories of age, medical and psychological comorbidity and body mass index (BMI). We hypothesized that post-TKA PROs would improve over time (hypothesis 1) and that most time-trends in improving PROs will be seen in the oldest, and in those with lower comorbidity and lower BMI (hypotheses 2–4).
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