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Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients



Total knee arthroplasty (TKA) is usually effective, although not all patients have satisfactory outcomes. This assumes distinct recovery patterns might exist. Little attention has been paid to determine which patients have worse outcomes. This study attempts to distinguish specific recovery patterns using the Oxford knee score (OKS) during the first postoperative year. The secondary aim was to explore predictors of less favourable recovery patterns.


Analysis of patients in the Dutch Arthroplasty Register (LROI) with unilateral primary TKA. Data collected up to one year postoperative was used. To identify subgroups of patients based on OKS, latent class growth modeling (LCGM) was used. Moreover, multivariable multinomial logistic regression analysis was used to explore predictors of class membership.


809 Patients completed three OKS during the first year postoperative and were included. LCGM identified 3 groups of patients; ‘high risers’ (most improvement during first 6-months, good 12-month scores 77%), ‘gradual progressors’ (continuous improvement during the first year 13%) and ‘non responders’ (initial improvement and subsequent deterioration to baseline score 10%). Predictors of least favourable class membership (OR, 95%CI) are EQ-5D items: VAS health score (0.83, 0.73–0.95), selfcare (2.22, 1.09–4.54) and anxiety/depression (2.45, 1.33–4.52).


Three recovery patterns after TKA were distinguished; ‘high risers', ‘gradual progressors' and ‘non responders'. Worse score on EQ-5D items VAS health, selfcare, and anxiety/depression were correlated with the least favourable ‘non responders’ recovery pattern.

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The authors would like to thank LROI for using the data. Moreover, we would like to thank the Van Rens Fonds for financially supporting this study.


This study was funded by the Van Rens Fonds Foundation (VRF2017-005), The Netherlands.

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Authors and Affiliations



JE performed data-analysis, he wrote and revised the manuscript for important intellectual content. BH supported data-analysis and critically reviewed the manuscript for important intellectual content. MM designed the study and critically reviewed the manuscript for important intellectual content. SV designed the study and critically reviewed the manuscript for important intellectual content and wrote the funding application. LS designed the study, provided data from the Dutch Arthroplasty Register (LROI) and critically reviewed the manuscript for important intellectual content. NM designed the study, supported data analysis and critically reviewed the manuscript for important intellectual content. JP designed the study, supported data analysis, critically reviewed the manuscript for important intellectual content and wrote the funding application. All authors approved the final version of the manuscript.

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Correspondence to Jeroen C. van Egmond.

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S.B.W. Vehmeijer has a consultancy contract with Zimmer Biomet.

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van Egmond, J.C., Hesseling, B., Melles, M. et al. Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients. Knee Surg Sports Traumatol Arthrosc 29, 529–539 (2021).

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  • Total knee arthroplasty
  • Latent class growth modeling
  • Trajectories
  • Patient-reported outcome measurements