Study of Total Knee Arthroplasty Responses

The overall outcomes of TKR are favorable and the procedure is in general, cost effective at a macroeconomic level.  However, the value of specific care processes, especially during the transition from hospital to subsequent care, is uncertain. Many organizations (such as Partners HealthCare, which delivers substantial number of TKRs costing about $26 million/year) wish to create global care programs for TKR and other complex procedures. These programs need to identify and remedy aspects of the process of care that lead to fragmentation, suboptimal care and potentially, adverse outcomes. Analysis of the data gathered in this study will provide insight into factors related to improving the value of TKR.

The goals of the STARs study are to:

1. Assemble and follow a prospective cohort of TKR recipients from multiple centers to estimate the frequency of suboptimal TKR response.
2. Identify risk factors for suboptimal TKR response, focusing primarily on psychosocial risk factors (e.g. depression, anxiety, pain catastrophizing).
3. Develop and validate a screening tool to identify patients at risk for suboptimal TKR response.
4. Determine the cost-effectiveness of TKR in subsets defined by the presence or absence of risk factors for suboptimal response.

Patients of Dr. David Dalury at Towson Orthopaedic Associates, Dr. Kirk Kindsfater at the Orthopaedic & Spine Center of the Rockies, and Dr. Richard Iorio at the NYU Langone Medical Center were recruited into the study.