# Similar PROMs and Healthcare Utilization in Patients Undergoing Total Knee Arthroplasty with and Without Prior Knee Hardware

## TL;DR

Patients with prior knee hardware undergoing TKA have similar outcomes and healthcare use as those without hardware.

## Contribution

First comparison of PROMs and healthcare utilization in TKA patients with different types of prior knee hardware.

## Key findings

- No significant differences in 1-year PROMs (KOOS-Pain, PS, JR) between groups.
- Healthcare utilization metrics like LOS, readmissions, and ED visits were similar across groups.
- Mortality and reoperation rates were comparable among patients with and without prior knee hardware.

## Abstract

Total knee arthroplasty (TKA) in patients with prior knee hardware presents unique surgical challenges and may increase complication risks. However, data on patient-reported outcome measures (PROMs) and healthcare utilization in this population are limited. This study aimed to compare clinically significant improvements in 1-year PROMs, healthcare utilization, and survivorship free from reoperation at 1 year among three groups: plate and screws, intramedullary nail, and control.

From 2016 to 2023, 51 TKAs with prior knee hardware (36 plate and screws, 15 intramedullary nails) were matched to 102 controls. PROMs included 1-year Knee injury Osteoarthritis Outcome Score (KOOS) for Pain, Joint Replacement (JR), and Physical function Shortform (PS), assessed by achievement of Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS). Healthcare utilization metrics included length of stay (LOS), 90-day readmissions, emergency department (ED) visits, discharge disposition (DD), and utilization of stems. Survivorship was determined by 1-year mortality and reoperations.

There were no significant differences in 1-year KOOS-Pain (p = 0.94), PS (p = 0.91), and JR (p = 0.9). Rates of achieving MCID and PASS thresholds were similar. Differences in LOS (p = 0.15), 90-day readmissions (p = 0.61), ED visits (p = 0.11), DD (p = 0.13), and stem use (p > 0.05) were insignificant. Mortality (p = 1) and reoperation rates (p = 0.69) were also comparable.

TKA in patients with prior knee hardware yielded similar 1-year PROMs, healthcare utilization, and survivorship to those without hardware. Understanding management strategies is crucial to optimize outcomes in this complex patient population.