Background/Purpose: Compared to the general population, Veterans have higher prevalence of knee osteoarthritis, comorbidities, activities of daily living limitations, and healthcare utilization following total knee arthroplasty (TKA). Despite these limitations, there is a significant gap in knowledge regarding how physical therapy care is delivered and what factors influence recovery for Veterans. To address this gap, we examined Veteran outcomes and physical therapy care delivery after TKA.

Methods: We recruited 86 Veterans [74 male, age 68±8 (mean ± standard deviation), body mass index 31±4.5, Charlson Comorbidity Index 1±1] who attended rehabilitation following TKA for ≥1 session in two Veterans Integrated Service Networks. We collected preoperative outcomes for knee range of motion, the timed up and go test, and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR). The KOOS JR was collected postoperatively at 90-days (primary outcome) and at 180-days. Physical therapy care outcomes were collected from the electronic medical record from April 2022 to April 2025 including time to physical therapy evaluation, duration of care, and number of visits.   Paired t-tests were performed to assess changes in KOOS JR scores from preoperative values at 90-day and 180-day. Pearson correlation coefficients were calculated on the relationship between the 90-day KOOS JR scores and preoperative characteristics (KOOS JR scores, the timed up and go test, knee flexion, knee extension) as well as time to outpatient evaluation, number of visits, and duration of care.

Results: Prior to surgery the Veterans were recorded to have 115±11⁰ of knee flexion, 11.5±4 seconds on the timed up and go test, and a KOOS JR interval score of 49.9±13. On average, 90-day KOOS JR scores were 18.6±2.0 points higher than preoperative scores (95% Confidence Interval 14.8, 22.9, p< .001). On average, the 180-day KOOS JR scores were 26.9±3.4 points higher than preoperative scores (95% Cl 20.0, 33.8, p< .001) and 8.1±2.0 points higher than the 90-day KOOS JR scores (95% Cl 3.9, 12.4, p< .001). Number of visits (11±6 visits, r= -0.26, p< 0.001) and time to outpatient evaluation from (15±14 days, r = -0.25, p< 0.001) were negatively correlated with 90-day KOOS JR scores. Preoperative KOOS JR scores (r = 0.26, p< .001) and preoperative knee flexion (r = 0.16, p< .001) were positively correlated with 90-day KOOS JR scores.

Conclusion: Despite the significant change in scores following TKA, on average these Veterans did not meet the threshold associated with meaningful change in physical function on the 90-day KOOS JR (≥ 27). The negative correlation between the number of visits and time to outpatient evaluation may result from these Veterans having poor recovery, increasing the need for additional services such as home health rehabilitation, sub-acute rehabilitation, or skilled nursing facility stays prior to outpatient physical therapy. Veterans with worse preoperative KOOS JR scores and reduced knee flexion may benefit from enhanced postoperative care. Additionally, factors related to postoperative care pathways should be explored to improve outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/veteran-rehabilitation-physical-therapy-care-delivery-and-outcomes-after-total-knee-arthroplasty/