The Effect of Comorbidities on Outcomes following Total Knee Arthroplasty

Abstract

To enhance the success of total knee arthroplasty (TKA), clinicians must identify factors that may impede functional recovery. Multiple comorbidities may affect outcomes, and our purpose was to identify the role of overall disease burden, as well as individual comorbidities, on post-TKA outcomes. We prospectively reviewed 283 TKA patients (172 women, 111 men). Preexisting comorbidities were weighted using the Charlson comorbidity index (CCI). Patients were divided into four groups: CCI score of 0 to 1, 2, 3, or 4 or more and followed up at 6 weeks, 3 months, 1 year, and annually until 5 years. The most prevalent comorbidities were also individually assessed at these follow-ups. The effect of these on outcomes was evaluated using the Knee Society Score (KSS), Short Form 36 (SF-36), and lower extremity activity scale (LEAS). Patients who had lower CCI scores had significant improvements in KSS at 2- and 5-year follow-up (+34 and +38 points, respectively; p < 0.01). CCI scores of 0 to l demonstrated significantly greater improvement in the SF-36 physical component score (PCS) at final follow-up (+16 points; p < 0.05) and higher LEAS scores at 2 years postoperatively (p = 0.001), compared with the remaining cohorts. Endocrine disease and hypertension yielded significantly lower KSS at follow-up (-5 and -5 points, respectively; p < 0.05). Patients who had hypertension or gastrointestinal disease had significantly lower SF-36 PCS at final follow-up compared with those who did not (45 vs. 48 points and 47 vs. 49 points; p < 0.035 and 0.041, respectively), as well as lower activity scores (11 vs. 12 points for both comorbidities; p < 0.05). Patients who had cardiovascular disease had significantly lower SF-36 MCS (53 vs. 56 points, respectively; p = 0.03) at 4 years postoperatively than those without, as well as lower activity scores (11 vs. 12 points, respectively; p = 0.024). Patients who have lower CCIs may have improved activity and functional levels following TKA. Hypertension, cardiovascular disease, endocrine disease, and gastrointestinal disease may correlate with poorer functional and activity outcomes postoperatively.

Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up

“…Comorbidities have not been accounted for, even though patients’ comorbidities can influence outcome after TKA [36, 37]. This issue has partly been addressed by only including ASA I and II patients.…”

Postoperative Infection in Cementless and Cemented Total Knee Arthroplasty: A Propensity Score Matched Analysis

“…Total joint arthroplasty (TJA) outcomes have previously been shown to be associated with CCI scores. 25 To calculate CCI scores, the following 17 comorbid conditions and their assigned point values were used: myocardial infarction (1); congestive heart failure (1); peripheral vascular disease (1); rheumatic or connective tissue disease (1); diabetes (1); diabetes with end-organ damage (2); renal disease (2); malignancy (2); metastatic solid tumor (6); HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) (6); cerebrovascular disease (1); dementia (1); hemiplegia (2); pulmonary disease (1); mild liver disease (2); severe liver disease (3); and gastric or peptic ulcer disease (1).…”

A patient’s perception of their hospital stay influences the functional outcome and satisfaction of total knee arthroplasty

“…A second limitation of the study was using a non-validated assessment tool to assess comorbidity, we simply recorded whether a specific comorbidity was present or not. A recent study using the validated Charlson comorbidity index demonstrated a worse functional outcome with increasing severity of the score [12]. However, we did include specific comorbidities in the regression models that have been shown to influence functional outcome and patient satisfaction, such as depression [7], back pain [10], general health [5], and diabetes [8], and adjusted for the effect of these upon outcome.…”