DAYTON, OH — Service connection (SC) status appears to worsen outcomes for veterans receiving total knee-arthroplasty, according to a new report.
The article in the Journal of Orthopedics noted that civilian patients receiving workers’ compensation (WC) are known to be more likely to have poor outcomes from elective orthopedic surgeries.
“However, little is known about surgical outcomes in veterans receiving similar benefits through the Veterans Affairs (VA) service-connected (SC) disability compensation program,” wrote the authors from Wright State University Department of Orthopedic Surgery.1
To find out, the study team analyzed veterans undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a VAMCs between July 2019 and December 2021, taking into account SC disability status.
Outcomes were evaluated 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) collected preoperatively and at two- and 12-months postoperatively. The analysis included 67 hips and 142 knees.
“SC and non-SC (NSC) veterans had similar baseline HOOS-JR/KOOS-JR and CCI. HOOS-JR remained similar between groups through 12 months (79.9 ± 19.2 vs. 82.7 ± 18.8) as did KOOS-JR (70.4 ± 15.6 vs. 74.6 ± 15.3),” the authors explained. “The designation of any SC and mental health SC reached significance for KOOS-JR (P = 0.034 and P = 0.032, respectively). For HOOS-JR and KOOS-JR, baseline function score quartile significantly influenced final score (P < 0.001), with patients in the lowest quartiles (i.e., the worst baseline function) exhibiting significantly greater improvements than patients in higher quartiles.”
The authors concluded that mental health SC and high preoperative functional status are variables that are more likely to lead to unfavorable influences on self-reported outcomes of TKA in veteran patients. “SC status does not appear to influence the outcomes of THA or the likelihood of achieving [substantial clinical benefit] after either THA or TKA,” they added. “Regardless of SC status, most veterans can expect significant clinical improvements after total joint arthroplasty.”
- Via GG, Brueggeman DA, Lyons JG, Froehle AW, Krishnamurthy AB. Effects of veterans’ mental health service-connections on patient-reported outcomes following total joint arthroplasty. J Orthop. 2022 Oct 12;34:379-384. doi: 10.1016/j.jor.2022.10.004. PMID: 36275490; PMCID: PMC9579445