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J Knee Surg 2023; 36(13): 1386-1390
DOI: 10.1055/s-0042-1758773
Original Article

The Association of Patient and Procedural Factors on Improved Outcomes: A Cluster Analysis on 853 Total Knee Arthroplasty Patients

Emily Hampp
1   Division of Joint Replacement, Stryker, Mahwah, New Jersey
,
Sarah Shi
1   Division of Joint Replacement, Stryker, Mahwah, New Jersey
,
Laura Scholl
1   Division of Joint Replacement, Stryker, Mahwah, New Jersey
,
Kelly B. Taylor
2   Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
,
Kevin B. Marchand
2   Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
,
Michael E. Kahan
3   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Zhongming Chen 
3   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Robert C. Marchand
2   Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
,
Michael A. Mont
3   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Abstract

Many studies involving robotic-assisted total knee arthroplasty (RATKA) have demonstrated superiority regarding soft tissue balance and consistency with alignment target achievement. However, studies investigating whether RATKA is associated with improved patient outcomes regarding physical function and pain are also important. Therefore, we performed a cluster analysis and examined factors that contributed to differences in patient-reported outcome measures (PROMs). Specifically, we analyzed: (1) reduced WOMAC (rWOMAC) scores regarding pain and function; (2) usage of RATKA; (3) common patient comorbidities; as well as (4) patient demographic factors. The rWOMAC score is an abbreviated PROM that includes pain and physical function domains. This study analyzed 853 patients (95 conventional and 758 robotic-assisted) who had completed preoperative, 6-month, and 1-year postoperative rWOMAC surveys. Two clusters were constructed using rWOMAC pain and function scores at 1 year. Cluster 1 included 753 patients who had better outcomes at 1 year (mean rWOMAC pain = 0.9, mean rWOMAC function = 1.4), and cluster 2 included 100 patients who had worse outcomes at 1 year (mean rWOMAC pain = 7.7, mean rWOMAC function = 10.4). The clusters were compared to determine (1) how scores improved and (2) what patient characteristics were significantly different between clusters. Cluster 1 demonstrated greater improvement from preoperative to 6 months or 1 year (p = 0.0013 for pain preoperative to 6 months, p< 0.0001 for other measures) and 6 months to 1 year (p< 0.0001). Comparisons demonstrated that cluster 1 had older patients (67 vs. 65 years, p = 0.0479) who had lower body mass index or BMIs (31.8 vs. 33.9 kg/m2, p = 0.0042) and no significant differences in sex (p = 0.7849). Cluster 1 also had a significantly higher percentage of RATKA patients (90 vs. 79%, p< 0.001). Cluster analyses provided differentiating factors which were associated with improved postoperative rWOMAC pain and function scores at 1 year. Patients undergoing robotic-assisted TKA were associated with better rWOMAC pain and function scores from preoperative to 6 months and 1 year.

Keywords

factors - outcomes - cluster analysis - total knee arthroplasty - robotic-assisted


Publication History

Received: 08 March 2022

Accepted: 15 September 2022

Article published online:
23 December 2022

© 2022. Thieme. All rights reserved.

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