Original research| Volume 99, ISSUE 5, P887-892, May 2018

Prevalence and Predictors of Symptom Resolution and Functional Restoration in the Index Knee After Knee Arthroplasty: A Longitudinal Study

  • Daniel L. Riddle
    Corresponding author Daniel L. Riddle, PT, PhD, FAPTA, Department of Physical Therapy, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23298.
    Departments of Physical Therapy and Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA
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Published:January 09, 2018DOI:


      • Composite scores of multiple measures to fully reflect pain outcomes in addition to pain plus other symptoms outcomes were developed for patients undergoing knee arthroplasty.
      • Complete resolution of pain in the index knee occurs in about a third of the time after knee replacement surgery recovery.
      • Complete pain plus other symptoms resolution is much less frequent, ∼14% of the time.
      • Complete functional restoration occurred in ∼29% of subjects.
      • These findings can more fully inform shared decision-making discussions with patients.



      To determine the prevalence of a 1- to 2-year postsurgical pain-free state and pain plus symptom-free state as well as functional restoration after knee arthroplasty (KA) and to identify predictors of these outcomes.


      Cohort study.


      Communities of 4 sites.


      Consecutive participants (N=383) who underwent KA on at least 1 knee during the first 8 years of the study (mean age, 67.95±8.5y; 61.4% women; n=235).


      Not applicable.

      Main Outcome Measures

      A composite pain score included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale and 2 generic pain rating scales. Composite pain plus other symptoms scores included 3 pain scales, a stiffness scale, and, in addition, the Knee injury and Osteoarthritis Outcome Score Symptoms scale. The WOMAC Function scale was used to quantify functional status. Prevalence estimates and predictors of a pain-free state, symptom-free state, and a fully functioning state were determined.


      A sample of 383 participants with KA was studied, and of these, 34.1% (95% confidence interval [CI], 29.3%–39.2%; n=131) had a composite score of 0 for pain. A total of 14.1% (95% CI, 10.8%–18.1%; n=54) had a composite score of 0, indicating a symptom-free state, whereas 29.0% (95% CI, 24.4%–34.0%; n=111) achieved a score of 0 on the WOMAC Function scale.


      The prevalence of complete pain relief was 34%, the prevalence of complete pain and symptom relief was 14%, and the prevalence of complete functional restoration was 29% after KA. Participants who are older and with lower (better) WOMAC Pain scores were more likely to be pain-free after surgery. These data collected from a community-based sample have the potential to inform clinicians screening patients for KA consultation in a shared decision-making discussion to better align patient expectations with the most likely outcome.


      List of abbreviations:

      CI (Confidence interval), KA (Knee arthroplasty), KOOS (Knee injury and Osteoarthritis Outcome Score), OAI (Osteoarthritis Initiative), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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