Recovery Benchmarks After Total Knee Arthroplasty: The Impact of Motion-Restoring Surgery, Contracture, and Comorbidities on Costs and Utilizationtal Knee Arthroplasty.

Abstract

This study aimed to establish a claims-based timeline for recovery following unilateral total knee arthroplasty (TKA), including the impact of comorbidities and postoperative complications such as motion-restoring surgery and joint contracture. Healthcare claims data were analyzed to determine the costs and recovery timeline after unilateral TKA. Costs related to i) index surgery, ii) complication surgery, iii) TKA revision, iv) nonoperative hospitalization, v) motion-restoring surgery, and vi) outpatient surgery were reported. The effect of joint contracture and comorbidities, including diabetes, obesity, peripheral vascular disease, joint infection, and cardiovascular disease, was assessed. The effect of postoperative complications was determined using data from patients rehospitalized with or without additional surgery. Index surgery median cost was $30,346 (interquartile range (IQR): 14,203 to 350,304). Median recovery time (from index surgery to last physical therapy claim) was 126 days (IQR: 30 to 975), based on Physical Therapy (PT) billing claims, which may not reflect full functional recovery. While 54% of patients completed their postoperative period in six months, 46% took over six months. Recovery periods for patients who required a complicated surgery were six times longer, and costs were 14 times higher than for those who did not have complications. Nonoperative hospitalizations for pulmonary embolus and/or infection increased the postoperative period four times at a cost of $25,430 per event. Comorbidities further compounded these challenges, with increased recovery times depending on the condition. Complications and comorbidities following TKA are associated with longer recovery times and higher healthcare costs. Motion-restoring surgeries, typically for postoperative joint contracture, further increase recovery duration, costs, and revision risk. These findings highlight the importance of early intervention and complication prevention to reduce the need for additional procedures, shorten recovery, and lower overall healthcare costs.