JOA - 2026-06-19 - Journal Article
Factors Associated with Patient-Reported Outcome Measure Non-Completion One Year after Total Joint Arthroplasty: A Retrospective Cohort Study.
Driessche AM, Zamzam M, Hodson N, Keinath C, Rubinfeld I, Charters M
Topics
Key Takeaway
Inactive patient portal use was the strongest predictor of 1-year PROM noncompletion after TJA (OR 5.85 for HOOS-JR, OR 3.28 for KOOS-JR), with overall 1-year completion rates peaking at only 44.1% (HOOS-JR) and 48.3% (KOOS-JR) despite >90% preoperative completion.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study identified demographic, clinical, and socioeconomic predictors of 1-year HOOS-JR and KOOS-JR noncompletion in 7,424 primary TJA patients at a single health system (2021–2023). Multivariable regression identified inactive patient portal use (OR 5.85 THA, OR 3.28 TKA), preoperative opioid use (OR ~1.37–1.38 for both), and high Social Vulnerability Index quartile (OR 1.36, TKA only) as independent predictors of noncompletion. Despite >90% preoperative completion, 1-year completion rates reached only 44.1% (HOOS-JR) and 48.3% (KOOS-JR) even after improvement over the study period.
Key Limitation
Single-institution design means the specific portal infrastructure, outreach protocols, and patient population may not reflect completion barriers at centers with different EHR systems or demographic mixes.
Original Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.