Regional differences between the US, Scandinavia, and South Korea in patient demographics and patient-reported outcomes for primary total knee arthroplasty
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Differences in total knee arthroplasty (TKA) patient demographics and clinical outcomes may exist between international regions, yet research is limited. The aim of this study was, therefore, to compare TKA patient demographics and patient-reported outcome measure (PROM) scores between the US, Scandinavia, and South Korea.
Materials and methods
A total of 398 TKA patients from three regions were assessed: 169 in Scandinavia (3 centers), 129 in the US (3 centers), and 100 patients in South Korea (2 centers). Regional variation in patient demographics was assessed using Kruskal–Wallis H tests. Regional variation in PROM scores from preoperative, 1-, 3- and 5-year visits was assessed using piecewise linear mixed effect models. The PROMs analyzed were a numerical rating scale for satisfaction and the Knee Osteoarthritis Outcome Score.
South Korean patients were the oldest (p < 0.001) and had the highest Charnley class (p < 0.001); US patients had the highest BMI (p < 0.001); Scandinavian patients had the lowest preoperative KL grade (p < 0.001). Scandinavian patients were associated with better preoperative and worse postoperative PROM scores. Scandinavian patients were also associated with moderately lower levels of satisfaction. These differences were lessened but remained significant after controlling for relevant demographic and surgical factors.
Regional differences were found in TKA patient demographics and PROMs between the US, Scandinavia, and South Korea. The regional differences in patient demographics support the need for more research and clear guidelines related to TKA appropriateness criteria. The better preoperative and worse postoperative Scandinavian PROM scores may have been related to their less severe KL grade but might also reflect cultural differences in how patients reflect on their health state when answering PROMs. Clinicians should be aware of these international differences in PROM scores when interpreting studies conducted in different international regions. Future studies should investigate TKA variation between more international regions and assess intraregional variation.
Level of evidence
KeywordsTotal knee arthroplasty Total knee replacement Osteoarthritis Regional differences Patient-reported outcome measures Satisfaction
We received no funding for this specific analysis. Data collection for the cohort of patients included in this study has been supported with funding from Zimmer Biomet. The institutions and Zimmer Biomet signed a standard legal study agreement whereby economic support was granted unconditionally and the manufacturer would have no influence on study design, data analysis, or publication.
Compliance with ethical standards
Conflict of interest
Authors NS, VPG, PR, YECI, ISF, CSN, AK, and CRB report no conflicts of interest. Author HM reports board membership for and stock membership in RSA Biomedical, research support from Biomet, Smith & Nephew, DePuy, Zimmer, and MAKO, and royalties from Zimmer, Biomet, Corin, and RSA Biomedical. Author AT reports paid speakership, paid consultancy, and research support from Zimmer Biomet, as well as board membership or committee appointment for the European Knee Society (EKS).
Institutional review board or local ethics committee approval was obtained at each center, and at the Academic Coordinating Research Organization.
Informed consent was obtained from all individual participants included in the study in accordance with the declaration of Helsinki.
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