Background Total knee replacement (TKR) is a common procedure in older adults. Physical resilience may be a useful construct to explain variable outcomes. We sought to define a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes. Methods Secondary analysis of Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, a prospective registry of total joint replacement. The analysis included 7 239 adults aged 60 or older who underwent TKR between 2011 and 2015. Measures included sociodemographic and health factors. Outcomes were categorized as physically resilient versus nonresilient based on the change from baseline to 1-year follow-up for 3 patient-reported outcomes: the physical component summary (PCS), bodily pain (BP), and vitality (VT) from the Short Form-36 subcomponent scores, at preop and 1-year postprocedure. Associations were expressed as relative risk (RR) of physically nonresilient outcomes using generalized linear regression models, with Poisson distribution and log link. Results Age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across PCS, BP, and VT: age, per 5 years for PCS (RR = 1.18 [1.12–1.23]), BP (RR = 1.06 [1.01–1.11), and VT (RR = 1.09 [1.06–1.12]); body mass index, per 5 kg/m2, for PCS (RR = 1.13 [1.07–1.19]), BP (RR = 1.06 [1.00–1.11]), and VT (RR = 1.08 [1.04–1.11]); and CCI for PCS CCI = 1 (RR = 1.38 [1.20–1.59]), CCI = 2–5 (RR = 1.59 [1.35–1.88]), CCI ≥6 (RR = 1.55 [1.31–1.83]. Household income >$45 000 associated with lower risk for PCS (RR = 0.81 [0.70–0.93]), BP (RR = 0.80 [0.69–0.91]), and VT (RR = 0.86 [0.78–0.93]). Conclusions We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.

中文翻译：

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全膝关节置换术后老年人非弹性结果的危险因素

背景 全膝关节置换术 (TKR) 是老年人的常见手术。身体复原力可能是解释可变结果的有用结构。我们试图定义一个简单的身体弹性测量方法，并确定非弹性患者结果的风险因素。方法 对全关节置换（FORCE-TJR）队列研究的功能和结果研究进行二次分析，这是一项全关节置换的前瞻性登记。该分析包括 2011 年至 2015 年期间接受 TKR 的 7 239 名 60 岁或以上的成年人。措施包括社会人口和健康因素。根据从基线到 1 年随访的 3 种患者报告结果的变化，将结果分为身体有弹性与无弹性：身体成分总结 (PCS)、身体疼痛 (BP)、术前和术后 1 年的 Short Form-36 子组件评分中的活力 (VT)。使用广义线性回归模型，使用泊松分布和对数链接，将关联表示为身体非弹性结果的相对风险 (RR)。结果 年龄、体重指数和查尔森合并症指数 (CCI) 与 PCS、BP 和 VT 的身体非弹性结局风险增加相关：PCS 的年龄，每 5 年 (RR = 1.18 [1.12–1.23])，BP (RR = 1.06 [1.01–1.11)，和 VT (RR = 1.09 [1.06–1.12])；PCS (RR = 1.13 [1.07–1.19])、BP (RR = 1.06 [1.00–1.11]) 和 VT (RR = 1.08 [1.04–1.11]) 的体重指数，每 5 kg/m2；和 PCS 的 CCI CCI = 1 (RR = 1.38 [1.20–1.59]), CCI = 2–5 (RR = 1.59 [1.35–1.88]), CCI ≥6 (RR = 1.55 [1.31–1.83]。家庭收入 > ; 45 000 美元与 PCS 风险较低相关（RR = 0.81 [0. 70–0.93])、BP (RR = 0.80 [0.69–0.91]) 和 VT (RR = 0.86 [0.78–0.93])。结论 我们实施了身体恢复力并确定了预测 TKR 后恢复力的因素。这种方法可能有助于临床风险分层，指导进一步调查原因，并最终通过设计干预措施来帮助患者增强身体弹性。