Abstract
ObjectivesThe aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA).MethodsThis was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed.ResultsSeven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months. Key predictors were poor clinical status, widespread body pain, high expectation of postoperative pain and lack of active coping. The developed model based on these variables demonstrated good discrimination. At the optimal cut-off, the final model had a sensitivity of 83%, specificity of 61% and positive likelihood ratio of 2.11. Excellent agreement was found between observed and predicted outcomes, and there was no evidence of overfitting in the model.ConclusionWe have developed and validated a clinical prediction model that can be used to identify patients at high risk of a poor outcome after TKA. This clinical risk score may be an aid to shared decision-making between patient and clinician.
Highlights
Total knee arthroplasty (TKA) is one of the most common and effective treatments for severe knee osteoarthritis with over 100,000 knee replacements performed in the UK annually [1, 2]
721 participants provided data for the current analysis and 14% had a poor outcome at 6 months
This clinical risk score may be an aid to shared decision-making between patient and clinician
Summary
Total knee arthroplasty (TKA) is one of the most common and effective treatments for severe knee osteoarthritis with over 100,000 knee replacements performed in the UK annually [1, 2]. The importance of psychosocial and individual factors, as predictors of musculoskeletal outcomes has been increasingly recognised [14,15,16]. Adverse psychological factors such as anxiety and depression may have an effect on pain perception and mediate the development of chronic pain and disability [17, 18]. The relationship between psychosocial factors and TKA outcomes has been examined in several systematic reviews, which have consistently indicated poor preoperative mental health and pain catastrophizing to be strongly associated with greater postoperative pain and functional disability [7, 10, 19].
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