Evidence map›Paper›PMID 41068486›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

Heart failure patients demonstrate excellent 1-year outcomes after total knee arthroplasty despite high healthcare utilization.

Nickelas Huffman, Abizairie Sánchez-Feliciano, Khaled A Elmenawi, Shujaa T Khan, Ignacio Pasqualini, Benjamin E Jevnikar, Chao Zhang, Lakshmi Spandana Gudapati, Paulino Alvarez, Matthew E Deren and 1 more

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Nickelas HuffmanCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Abizairie Sánchez-FelicianoCase Western Reserve University School of Medicine, Cleveland, OH, USA.
Khaled A ElmenawiCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Shujaa T KhanCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Ignacio PasqualiniCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Benjamin E JevnikarCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Chao ZhangCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Lakshmi Spandana GudapatiCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Paulino AlvarezCleveland Clinic, Heart, Vascular, and Thoracic Institute, Cleveland, OH, USA.
Matthew E DerenCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
Nicolas S PiuzziCleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA. piuzzin@ccf.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeMany heart failure (HF) patients undergo total knee arthroplasty (TKA), but their postoperative outcomes remain unclear. This study aimed to compare healthcare resource utilization and patient-reported outcome measures (PROMs) after TKA between patients with and without HF.

methodsA retrospective analysis of 12,491 TKA at our institution from 2016 to 2021, including 495 with HF. HF patients were stratified into three ejection fraction (EF) categories: preserved (≥ 50%, n = 374), mildly reduced (41-49%, n = 53), and reduced (≤ 40%, n = 68). Healthcare utilization metrics and 1-year mortality were compared. PROMs were assessed using the Knee Injury and Osteoarthritis Outcome Score for Pain (KOOS-Pain), Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR) at baseline and 1-year postoperatively. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds were evaluated.

resultsHF patients had significantly higher odds of prolonged hospital stay (OR 2.55, p < 0.001), non-home discharge (OR 2.17, p < 0.001), 90-day readmission (OR 2.02, p < 0.001), 90-day emergency department visits (OR 1.55, p = 0.002), and 1-year mortality (OR 3.53, p = 0.007). PROMs were similar between HF and non-HF patients at 1 year, though HF patients were more likely to achieve MCID for KOOS-PS (p = 0.021). Among EF subgroups, patients with mildly reduced EF had significantly higher 1-year KOOS-Pain (p = 0.024) and PASS achievement for pain (p = 0.043). EF did not predict 1-year outcomes.

conclusionDespite increased healthcare utilization, HF patients undergoing TKA achieve similar improvements in pain and functionality as non-HF patients. HF severity was not associated with differential healthcare utilization, suggesting that risk stratification based on HF severity may not be necessary. Level of evidence III.

Indexed as

Arthroplasty, Replacement, KneeHeart FailureOsteoarthritis, KneePatient Acceptance of Health CareAgedAged, 80 and overFemaleHumansLength of StayMaleMiddle AgedPatient ReadmissionPatient Reported Outcome MeasuresRetrospective StudiesTreatment OutcomeHeart failureKnee disability and osteoarthritis outcome scorePatient-reported outcome measuresTotal knee arthroplasty

Identifiers

PMID41068486
PMCPMC12511152

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