Contralateral Total Knee Arthroplasty More Than One Year Apart: Do Patient-Reported Outcomes and Health Care Utilization Differ After Each Surgery?

Alvaro Ibaseta; Shujaa T Khan; Ignacio Pasqualini; Khaled A Elmenawi; Chao Zhang; Nicolas S Piuzzi; Cleveland Clinic Adult Reconstruction Research

doi:10.1016/j.arth.2025.09.016

Contralateral Total Knee Arthroplasty More Than One Year Apart: Do Patient-Reported Outcomes and Health Care Utilization Differ After Each Surgery?

J Arthroplasty. 2025 Sep 17:S0883-5403(25)01169-6. doi: 10.1016/j.arth.2025.09.016. Online ahead of print.

Authors

Alvaro Ibaseta¹, Shujaa T Khan¹, Ignacio Pasqualini¹, Khaled A Elmenawi¹, Chao Zhang¹, Nicolas S Piuzzi¹; Cleveland Clinic Adult Reconstruction Research¹

Collaborators

Cleveland Clinic Adult Reconstruction Research:
Alison K Klika, Lakshmi S Gudapati, Michael R Bloomfield, Trevor G Murray, Robert M Molloy, Viktor E Krebs, John P McLaughlin, Peter A Surace, Matthew E Deren

Affiliation

¹ Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

PMID: 40972990
DOI: 10.1016/j.arth.2025.09.016

Abstract

Background: This study aimed to evaluate health care utilization and patient-reported outcomes between the first and second asynchronous contralateral total knee arthroplasty (TKA) surgeries performed more than one year apart.

Methods: A cohort of 573 patients undergoing contralateral primary TKA (> one year between surgeries) from 2016 to 2021 was analyzed. The patient-reported outcome measures included Knee Disability and Osteoarthritis Outcome Score (KOOS) Pain, Physical Function Short-form (KOOS-PS), Joint Replacement scores, as well as Veterans Rand-12 mental component score. Achievement of minimal clinically important differences (MCIDs) and Patient Acceptable Symptom State was assessed for each outcome score. Health care utilization outcomes included discharge disposition, length of stay, and 90-day readmission rates.

Results: The mean time from first surgery to second surgery was 609 days (interquartile range: 439 to 893). Mean baseline KOOS-Pain (39 versus 44, P < 0.001), PS (52 versus 54, P < 0.001), and Joint Replacement (42 versus 47, P < 0.001) were significantly lower before the first surgery compared to the second surgery. The difference in all KOOS domains between baseline and 1-year postoperative score was significantly larger following the first surgery. More patients achieved an MCID for KOOS-PS after the first surgery (89 versus 83%, P = 0.012); however, there was no significant difference in MCID and Patient Acceptable Symptom State threshold achievement for the remaining KOOS domains. The achievement of 1-year satisfaction between the first and second surgery (94 versus 92%, P = 0.4) was not significantly different. The length of stay was significantly shorter following the second surgery (1.7 versus 1.4 days, P < 0.001), whereas there was no difference in discharge disposition or 90-day readmission between the first and second TKA surgeries.

Conclusions: In contralateral TKA with more than one year of difference between procedures, patients are likely to have a poorer baseline status before the first surgery as well as greater improvement after this procedure. However, meaningful clinical improvements can be expected after both surgeries, and health care utilization may be lower following the second surgery.

Keywords: PROMs; arthroplasty; bilateral; contralateral; knee; outcomes.