Lower 3- and 6-month postoperative patient-reported outcome measures are associated with treatment failure 2 years following osteochondral allograft transplantation in the knee.

Abstract

The reliability of patient-reported outcome measures (PROMs) as a predictive tool for delayed recovery at 2 years and long-term outcomes following osteochondral allograft transplantation (OCAT) remains uncertain. The objective of this study was to evaluate baseline and 3- to 6-month PROMs for association with 2-year treatment outcomes in primary OCAT patients. Patients were prospectively enrolled in a dedicated OCAT registry at a single institution. Preoperative, 3-, 6-month and annual PROMs for function, pain and global health were analysed for associations with recovery and treatment failure, defined as conversion to a total knee arthroplasty (TKA) or revision surgery within 2 years. Two hundred and seventeen primary OCAT patients were included for analyses; 34 patients experienced treatment failure with 8 undergoing revision and 26 undergoing TKA at a mean timepoint of 15.5 months. Changes in PROMIS Physical Health, PROMIS Physical Function and PROMIS Pain Interference scores from preoperative status were significantly different between 2-year success versus failure cohorts. Absence of mental health history (odds ratio [OR] 2.9, p = 0.033) and lower preoperative International Knee Documentation Committee (IKDC) scores (p = 0.001) were associated with meeting visual analog scale and IKDC minimal clinically important differences at 1 year. Male sex (p = 0.055), nonadherence (p ≤ 0.001, OR: 4.03) and surgery type (tibiofemoral bipolar) (<0.001, OR: 11.3) were significantly associated with increased risk for treatment failure. Preoperative and 3-6 months PROMs may be useful for identifying patients at-risk for delayed recovery or early failure 2 years following OCAT in the knee in combination with other known risk factors. These findings have significant implications for shared decision-making regarding OCAT indications, timing, patient education and expectations. Level III, cross-sectional analysis of prospectively collected registry data.