Early Postoperative Functional Outcomes Following Total Knee Arthroplasty: The Role of Preoperative Disease Severity and Patient-Related Factors

Abstract

Objective: To determine early functional outcomes following primary total knee arthroplasty and assess the influence of preoperative disease severity and patient-related factors.

Methods: This prospective multicenter cohort study included 65 adults who underwent primary unilateral total knee arthroplasty for knee osteoarthritis at three tertiary-care hospitals in Punjab, Pakistan, from January to December, 2025. Radiographic severity was classified using Kellgren–Lawrence grades III and IV. Outcomes were assessed preoperatively and at 6 and 12 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index. Pain, knee movement, body mass index, comorbidities and rehabilitation adherence were also recorded. Multivariable linear regression identified predictors of the 12-week WOMAC score.

Results: The mean age was 64.2±7.1 years, and 43 (66.2%) patients were women. Thirty-eight patients (58.5%) had grade-IV osteoarthritis. The mean total WOMAC score improved from 68.4±10.5 preoperatively to 27.8±9.1 at 12 weeks (p<0.001). Grade-IV patients had poorer absolute function at 12 weeks than grade-III patients, although both groups demonstrated comparable improvement. Higher preoperative WOMAC score, greater body mass index, diabetes, grade-IV disease and inadequate rehabilitation adherence independently predicted poorer 12-week outcomes.

Conclusion: Total knee arthroplasty produced considerable early improvement. Preoperative disability, obesity, diabetes, advanced radiographic disease and rehabilitation adherence influenced the pace of recovery.