Factors Associated with Patient-Reported Outcome Measure Non-Completion One Year after Total Joint Arthroplasty: A Retrospective Cohort Study.

Abstract

Patient-reported outcome measures (PROMs) collected one year after total hip or knee arthroplasty (THA/TKA) are important benchmarks for evaluating surgical success and are required for Medicare quality reporting. However, many patients do not complete 1-year PROMs. We aimed to identify factors associated with noncompletion of 1-year PROMs to inform strategies for improving completion rates. This retrospective cohort study included adults who underwent primary THA or TKA at a single health system between 2021 and 2023. We evaluated pre- and postoperative PROM completion rates using the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR). Univariate and multivariable regression analyses assessed the association of demographic, clinical, and socioeconomic factors with 1-year (300 to 425 days) postoperative PROM noncompletion. Preoperative PROM completion exceeded 90% across three years, and 1-year completion rates increased from 16.7 to 44.1% for HOOS-JR and 21.6 to 48.3% for KOOS-JR. Among 2,886 THA and 4,538 TKA patients, inactive patient portal use was the strongest predictor of 1-year PROM noncompletion (HOOS-JR: OR [odds ratio], 5.85; 95% CI [confidence interval], 3.51 to 9.73; KOOS-JR: OR, 3.28; 95% CI, 2.34 to 4.60; both q < 0.001). Preoperative opioid use was independently associated with noncompletion (HOOS-JR: OR, 1.37; 95% CI, 1.14 to 1.64; q < 0.01; KOOS-JR: OR, 1.38; 95% CI, 1.19 to 1.59; q < 0.001). The highest Social Vulnerability Index quartile was associated with noncompletion after TKA (OR, 1.36; 95% CI, 1.12 to 1.65; q = 0.03). Inactive patient portal use and preoperative opioid use were consistently associated with 1-year PROM noncompletion. Neighborhood socioeconomic vulnerability was independently associated with noncompletion after TKA but not THA, suggesting procedure-specific barriers. Targeted interventions addressing these modifiable factors may improve longitudinal PROM capture in arthroplasty registries.