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

PURPOSE: Many 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.

METHODS

A 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.

RESULTS

HF 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.

CONCLUSION

Despite 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.