The Relationship Between Patient-Reported Readiness for Total Knee Arthroplasty and the Likelihood of a Good Outcome at One Year

Gillian Hawker¹, Barbara Conner-Spady², Eric Bohm³, Michael Dunbar⁴, Allyson Jones⁵, Bheeshma Ravi¹, Tom Noseworthy², Linda Woodhouse⁶, Peter Faris⁷, Donald Dick⁸, James Powell², Paulose Paul⁵ and Deborah Marshall², ¹University of Toronto, Toronto, ON, Canada, ²University of Calgary, Calgary, AB, Canada, ³Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada, ⁴Dalhousie University, Halifax, NS, Canada, ⁵University of Alberta, Edmonton, AB, Canada, ⁶Curtin University, Perth, Western Australia, Australia, ⁷Alberta Health Services, Calgary, ON, Canada, ⁸Alberta Bone and Joint Health Institute, Edmonton, AB, Canada

Meeting: ACR Convergence 2020

Keywords: Arthroplasty, Osteoarthritis, Total joint replacement

Session Information

Date: Monday, November 9, 2020

Title: Osteoarthritis – Clinical Poster II

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: In prior qualitative research, we found that patients with knee osteoarthritis (OA) equated appropriateness for total knee arthroplasty (TKA) with candidacy for the procedure. Pain intensity, the ability to cope with the pain and how the pain affected quality of life were seen as important factors determining surgical candidacy. The importance of psychological readiness and a positive attitude, were additionally perceived as critical to achievement of a good TKA outcome. The current study examined the relationship between patients’ pre-operative psychological readiness for TKA and surgical outcome at one year.

Methods: This prospective cohort study recruited knee OA patients aged 30+ years referred for TKA at two hip/knee surgery centers in Alberta, Canada. All participants met ACR criteria for knee OA. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess TKA readiness (Patient Acceptable Symptom State – knee symptoms acceptable/unacceptable; Perceived Arthritis Coping Efficacy; General Self-Efficacy; definite willingness to undergo TKA – yes/no) and covariates (age, sex, WOMAC pain, Knee injury and Osteoarthritis Outcome Score Physical Function [KOOS-PS], Patient Health Questionnaire depression scale, BMI, comorbidities), and one year post-TKA to assess TKA outcome. A good TKA outcome was defined as improved knee symptoms (OARSI-OMERACT responder criteria) AND overall satisfaction with TKA results (yes/no). Using multivariable logistic regression, we examined the relationship of our exposures to a good TKA outcome, before and after controlling for covariates.

Results: Of 1,272 TKA recipients assessed at one year, 1,030 without complications and with data for the primary outcome were included (mean age 66.9 years [SD 8.8]; 58.5% female). 79.3% achieved a good TKA outcome. In multivariable analysis, controlling for covariates, unacceptable knee symptoms and definite willingness to undergo TKA were associated with higher odds of a good TKA outcome (adjusted ORs 1.55, 95% CI, 1.06 – 2.71, and 1.70, 95% CI 1.09 – 2.66, respectively).

Conclusion: Among OA TKA recipients, greater psychological readiness for TKA was associated with higher odds of a good TKA outcome. Incorporation of patient readiness in TKA decision-making may enhance patient outcomes and appropriate use of TKA.

Disclosure: G. Hawker, University of Toronto, 2; B. Conner-Spady, None; E. Bohm, None; M. Dunbar, None; A. Jones, None; B. Ravi, None; T. Noseworthy, None; L. Woodhouse, None; P. Faris, None; D. Dick, None; J. Powell, None; P. Paul, None; D. Marshall, University of Calgary, 2.

To cite this abstract in AMA style:

Hawker G, Conner-Spady B, Bohm E, Dunbar M, Jones A, Ravi B, Noseworthy T, Woodhouse L, Faris P, Dick D, Powell J, Paul P, Marshall D. The Relationship Between Patient-Reported Readiness for Total Knee Arthroplasty and the Likelihood of a Good Outcome at One Year [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/the-relationship-between-patient-reported-readiness-for-total-knee-arthroplasty-and-the-likelihood-of-a-good-outcome-at-one-year/. Accessed .

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