Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients.
PURPOSE
Total knee arthroplasty (TKA) is usually effective, although not all patients have satisfactory outcomes. This assumes distinct recovery patterns might exist. Little attention has been paid to determine which patients have worse outcomes. This study attempts to distinguish specific recovery patterns using the Oxford knee score (OKS) during the first postoperative year. The secondary aim was to explore predictors of less favourable recovery patterns.


METHODS
Analysis of patients in the Dutch Arthroplasty Register (LROI) with unilateral primary TKA. Data collected up to one year postoperative was used. To identify subgroups of patients based on OKS, latent class growth modeling (LCGM) was used. Moreover, multivariable multinomial logistic regression analysis was used to explore predictors of class membership.


RESULTS
809 Patients completed three OKS during the first year postoperative and were included. LCGM identified 3 groups of patients; 'high risers' (most improvement during first 6-months, good 12-month scores 77%), 'gradual progressors' (continuous improvement during the first year 13%) and 'non responders' (initial improvement and subsequent deterioration to baseline score 10%). Predictors of least favourable class membership (OR, 95%CI) are EQ-5D items: VAS health score (0.83, 0.73-0.95), selfcare (2.22, 1.09-4.54) and anxiety/depression (2.45, 1.33-4.52).


CONCLUSION
Three recovery patterns after TKA were distinguished; 'high risers', 'gradual progressors' and 'non responders'. Worse score on EQ-5D items VAS health, selfcare, and anxiety/depression were correlated with the least favourable 'non responders' recovery pattern.
['van Egmond|Jeroen C|JC|', 'Hesseling|Brechtje|B|', 'Melles|Marijke|M|', 'Vehmeijer|Stephan B W|SBW|', 'van Steenbergen|Liza N|LN|', 'Mathijssen|Nina M C|NMC|', 'Porsius|Jarry T|JT|']
D000368:Aged D001007:Anxiety D019645:Arthroplasty, Replacement, Knee D003863:Depression D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D020370:Osteoarthritis, Knee D011183:Postoperative Complications D012042:Registries D012044:Regression Analysis D012648:Self Care D016896:Treatment Outcome
Total knee arthroplasty Latent class growth modeling Patient-reported outcome measurements Trajectories