{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:24:05Z","timestamp":1771230245696,"version":"3.50.1"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Many heart failure (HF) patients undergo total knee arthroplasty (TKA), but their postoperative outcomes remain unclear. This study aimed to compare healthcare resource utilization and patient-reported outcome measures (PROMs) after TKA between patients with and without HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis of 12,491 TKA at our institution from 2016 to 2021, including 495 with HF. HF patients were stratified into three ejection fraction (EF) categories: preserved (\u2265\u200950%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009374), mildly reduced (41\u201349%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953), and reduced (\u2264\u200940%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200968). Healthcare utilization metrics and 1-year mortality were compared. PROMs were assessed using the Knee Injury and Osteoarthritis Outcome Score for Pain (KOOS-Pain), Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR) at baseline and 1-year postoperatively. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HF patients had significantly higher odds of prolonged hospital stay (OR 2.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), non-home discharge (OR 2.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), 90-day readmission (OR 2.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), 90-day emergency department visits (OR 1.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), and 1-year mortality (OR 3.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). PROMs were similar between HF and non-HF patients at 1\u00a0year, though HF patients were more likely to achieve MCID for KOOS-PS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021). Among EF subgroups, patients with mildly reduced EF had significantly higher 1-year KOOS-Pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024) and PASS achievement for pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). EF did not predict 1-year outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite increased healthcare utilization, HF patients undergoing TKA achieve similar improvements in pain and functionality as non-HF patients. HF severity was not associated with differential healthcare utilization, suggesting that risk stratification based on HF severity may not be necessary.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Level of evidence\u00a0<\/jats:italic>\n                      III.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04549-1","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:13:01Z","timestamp":1760026381000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Heart failure patients demonstrate excellent 1-year outcomes after total knee arthroplasty despite high healthcare utilization"],"prefix":"10.1007","volume":"35","author":[{"given":"Nickelas","family":"Huffman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abizairie","family":"S\u00e1nchez-Feliciano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled A","family":"Elmenawi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shujaa T","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Pasqualini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin E","family":"Jevnikar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lakshmi Spandana","family":"Gudapati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulino","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew E","family":"Deren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas S","family":"Piuzzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"4549_CR1","doi-asserted-by":"crossref","unstructured":"Lippi G, Sanchis-Gomar F (2020) Global epidemiology and future trends of heart failure. 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J Arthroplasty 32(3):719\u2013723","journal-title":"J Arthroplasty"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04549-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-025-04549-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04549-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:43:58Z","timestamp":1767015838000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-025-04549-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4549"],"URL":"https:\/\/doi.org\/10.1007\/s00590-025-04549-1","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"assertion":[{"value":"6 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare a research grants from Osteal Therapeutics, RegenLab, Zimmer, Peptilogics, and Signature Orthopaedics. There are affiliations with AAHKS, ISCT, and ORS as board or committee members, as well as editorial roles with the\n                      Journal of Hip Surgery\n                      and the\n                      Journal of Knee Surgery\n                      . There is also a consultancy relationship with Zimmer-Biomet. No other relevant affiliations or financial involvement exists with any organization or entity that has a financial interest in or conflict with the subject matter or materials discussed in this manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The observational study was approved by the local ethics committee at the Cleveland Clinic, OH and was conducted in accordance with the principles of the Declaration of Helsinki of 1964 and its later amendments. Informed consent was obtained prior to inclusion in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"424"}}