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Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Acknowledgements

The authors would like to thank LROI for using the data. Moreover, we would like to thank the Van Rens Fonds for financially supporting this study.

Funding

This study was funded by the Van Rens Fonds Foundation (VRF2017-005), The Netherlands.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands

    Jeroen C. van Egmond, Brechtje Hesseling, Stephan B. W. Vehmeijer & Nina M. C. Mathijssen

  2. Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE, Delft, The Netherlands

    Marijke Melles

  3. Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Marijke Melles

  4. Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten/LROI), Bruistensingel 230, 5232 AD, Hertogenbosch, The Netherlands

    Liza N. van Steenbergen

  5. Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Boston, MA, 02114, USA

    Jarry T. Porsius

  6. Department of Rehabilitation Medicine and the Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Jarry T. Porsius

Authors
  1. Jeroen C. van Egmond
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  2. Brechtje Hesseling
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  3. Marijke Melles
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  4. Stephan B. W. Vehmeijer
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  5. Liza N. van Steenbergen
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  6. Nina M. C. Mathijssen
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  7. Jarry T. Porsius
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Contributions

JE performed data-analysis, he wrote and revised the manuscript for important intellectual content. BH supported data-analysis and critically reviewed the manuscript for important intellectual content. MM designed the study and critically reviewed the manuscript for important intellectual content. SV designed the study and critically reviewed the manuscript for important intellectual content and wrote the funding application. LS designed the study, provided data from the Dutch Arthroplasty Register (LROI) and critically reviewed the manuscript for important intellectual content. NM designed the study, supported data analysis and critically reviewed the manuscript for important intellectual content. JP designed the study, supported data analysis, critically reviewed the manuscript for important intellectual content and wrote the funding application. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Jeroen C. van Egmond.

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Conflict of interest

S.B.W. Vehmeijer has a consultancy contract with Zimmer Biomet.

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van Egmond, J.C., Hesseling, B., Melles, M. et al. Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients. Knee Surg Sports Traumatol Arthrosc 29, 529–539 (2021). https://doi.org/10.1007/s00167-020-05969-8

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