{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:00:36Z","timestamp":1785517236004,"version":"3.56.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National University of Singapore Development Grant"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Qual Life Res"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patient-reported outcomes (PROs) after total knee arthroplasty (TKA) are well-documented in Western populations, but long-term recovery and its determinants in multiethnic Asian populations remain poorly understood. We aimed to characterise 5-year WOMAC recovery after TKA and to identify patient, clinical, and surgical factors associated with the odds of improvement at each consecutive postoperative interval in a multiethnic Asian cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This registry-based cohort study used prospectively collected data from a tertiary hospital in Singapore. We included 4964 consecutive cases with osteoarthritis undergoing primary TKA between December 1, 2008, and December 31, 2023. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and subscale scores, measured at baseline and at 6\u00a0months, 1, 2, and 5\u00a0years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean (SD) total WOMAC score improved from 38.6 (15.1) at baseline to 7.5 (9.2) at 5\u00a0years. The greatest improvement occurred within the first 6\u00a0months (mean change, 27.6 points; P value &lt;\u2009.001). In multivariable interval-specific analyses, older age (\u2265\u200975\u00a0years; OR 0.55, 95% CI 0.39\u20130.79) and the presence of one or more comorbidities (OR 0.83, 95% CI 0.71\u20130.96) were independently associated with lower odds of long-term improvement. Interval-specific associations with ethnicity were also observed for pain and stiffness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large, multi-ethnic Asian cohort, TKA was associated with substantial and durable WOMAC improvements, primarily within the first 6\u00a0months. Interval-specific predictors of improvement were dominated by patient-level factors, notably age, comorbidity, and ethnicity, while surgical variables showed limited association. These findings support the potential value of patient-centred risk stratification and culturally responsive perioperative care in optimising long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11136-026-04276-y","type":"journal-article","created":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T21:04:44Z","timestamp":1777842284000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["WOMAC-based recovery after total knee arthroplasty in a multiethnic Asian cohort: a 5-year registry-based study of interval-specific predictors of improvement"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8173-6057","authenticated-orcid":false,"given":"Eau Liang","family":"Teow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7678-4468","authenticated-orcid":false,"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0501-3698","authenticated-orcid":false,"given":"Wei Loong Barry","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5685-6911","authenticated-orcid":false,"given":"Chee Hoe","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9693-116X","authenticated-orcid":false,"given":"Harish","family":"Sivasubramanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6135-508X","authenticated-orcid":false,"given":"Xun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3866-1691","authenticated-orcid":false,"given":"Melvin Kian Loong","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0498-9237","authenticated-orcid":false,"given":"Zi Qiang Glen","family":"Liau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1510-3462","authenticated-orcid":false,"given":"Nick","family":"Bansback","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7980-6979","authenticated-orcid":false,"given":"Nan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0641-3060","authenticated-orcid":false,"given":"Wai San Wilson","family":"Tam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-578X","authenticated-orcid":false,"given":"Ling Jie","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"key":"4276_CR1","unstructured":"World Health Organization. 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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial or non-financial interests in the subject matter or materials discussed in this manuscript.","order":1,"name":"Ethics","label":"Conflict of Interest Statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the Domain Specific Review Board, National Healthcare Group, Singapore (DSRB 2024\/00191). All registry data were de-identified and anonymised prior to analysis.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to their inclusion in the registry and analysis.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"156"}}