How Physical and Psychosocial Support Affect TJA Outcomes

    Having someone at home to help provide a safe environment for recovery – whether a spouse or a live-in partner – contributes to a successful outcome of total knee arthroplasty (TKA) or total hip arthroplasty (THA), according to a study from NYU Langone Health.

    Researchers there found that, overall, married patients or those with a live-in partner experience shorter surgical times, shorter length of stay (LOS) in the hospital, fewer postoperative emergency department (ED) visits, lower readmission rates and, in some cases, better patient-reported outcome measures than those who aren’t married or who live alone.

    The study findings were presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons.

    “As orthopaedic surgeons, we help restore our patients’ mobility and strive to help our patients recuperate in an optimal environment,” said lead researcher Ran Schwarzkopf, MD, MSc. He is the Associate Chief of the Division of Adult Reconstruction, Department of Orthopedic Surgery, and Director of the Adult Reconstruction Research Center at NYU Langone Orthopedic Hospital.

    “My patient population is based in New York City, and given our urban setting, there are factors to consider such as non-elevator or walk-up buildings,” Dr. Schwarzkopf continued. “It’s not uncommon for me to have a TKA or THA patient who lives alone on the fourth floor. Having to go up and down stairs during recovery can be a major challenge for patients — even if they don’t reside in an urban area.”

    With his patient’s post-discharge needs in mind, Dr. Schwarzkopf is continually looking at factors that impact recovery in order to address and mitigate obstacles, as well as to optimize outcomes. One area of interest is access to physical and psychosocial support for patients following total joint arthroplasty — specifically, whether a patient is married or has a live-in partner to provide a sense of safety and comfort when recuperating at home after surgery.

    For the study, Dr. Schwarzkopf and his colleagues conducted a retrospective review of patients who had undergone primary THA (n=2146) or primary TKA (n=1242) between 2016 and 2020 at NYU Langone Health and who had available PROMs. Patients were separated into 2 groups based on whether they were married at the time of their procedure:

    • In the THA cohort, 1311 patients (61%) were married and 835 (39%) were not married.
    • In the TKA cohort, 689 patients (55%) were married and 553 (45%) were not married.

    Data were collected at various time points for:

    • Patient factors: Age, gender, BMI, race, smoking status, and ASA classification
    • Clinical factors: Surgical time, LOS, all-cause ED visits, 90-day all-cause readmissions, 90-day all-cause revisions, and discharge disposition
    • PROMs: Forgotten Joint Score-12; Hip Injury and Osteoarthritis Outcome Score, JR (HOOS, JR); Knee Injury and Osteoarthritis Outcome Score, JR (KOOS, JR); and the Physical Component Score (PCS) and Mental Component Score (MSC) of the Veterans RAND 12 Item Health Survey (VR-12)

    The findings of the study include the following:

    • Married patients had significantly shorter surgical time (88.5 minutes vs 93.8 minutes) and ED visits (1.5% vs 3.8%) for THA but not for TKA.
    • In both THA and TKA cohorts, married patients had a shorter LOS (THA: 1.4 vs 2.0 days; TKA: 2.0 vs 2.5 days), lower rates of 90-day all-cause readmissions (THA: 2.4% vs 5.1%; TKA: 2.5% vs 4.2%), and were more likely to be discharged home than to a rehabilitation center or nursing home (THA: 97.9% vs 91.1%; TKA: 94.3% vs 89.7%)
    • Married patients in the THA cohort reported significantly higher PROMs scores than patients who were not married. The 2 groups were not significantly different in the TKA cohort.

    “These findings demonstrate the integral role psychosocial support can play in the recuperation period,” Dr. Schwarzkopf said.

    “It’s imperative that the multidisciplinary healthcare team conduct a proper preoperative patient evaluation to determine any restrictions the patient faces or areas requiring additional support to help ensure the health and safety of patients post-surgery and throughout recovery.”


    Singh V, Kugelman DK, Lygrisse KA, Meftah M, Aggarwal V, Schwarzkopf R. Effect of Marital Status on Outcomes Following Total Joint Arthroplasty (Poster P0117). Presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons, August 31-September 3, San Diego, California.