{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:42:15Z","timestamp":1792194135700,"version":"4.4.0"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to develop and internally evaluate a multidimensional nomogram incorporating intraoperative cartilage damage and perioperative synovial fluid biomarkers to estimate the probability of poor functional recovery at 3 months after total knee arthroplasty (TKA). A retrospective cohort of 360 patients undergoing primary unilateral TKA was included in this study. Interleukin-6 (IL-6), tumor necrosis factor-\u03b1, cartilage oligomeric matrix protein (COMP), and total BDNF were measured in perioperative synovial fluid specimens collected after induction of anesthesia and before skin incision and were assessed together with intraoperative Outerbridge cartilage damage grade and routinely available demographic and clinical variables. The primary outcome was functional recovery at 3 months, defined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale. Least absolute shrinkage and selection operator regression was used for predictor selection, and a nomogram was developed using multivariable logistic regression. Model performance was evaluated using area under the curve (AUC), calibration, and decision curve analysis (DCA). Six predictors were retained in the final model: age, body mass index, preoperative WOMAC function score, Outerbridge grade, log(IL-6), and log(COMP). The nomogram showed promising discrimination in the held-out internal test set (AUC\u2009=\u20090.861, 95% CI: 0.782\u20130.934) and acceptable calibration (Hosmer\u2013Lemeshow test, p\u2009=\u20090.45). Bootstrap optimism correction yielded a bias-corrected AUC of 0.842. DCA suggested potential net benefit across the evaluated threshold probabilities. The nomogram integrates clinical characteristics, intraoperative cartilage damage, and perioperative synovial fluid biomarkers to estimate the probability of poor functional recovery at 3 months after TKA. It should be regarded as a development-stage perioperative prediction model that requires prospective external validation before any clinical application.<\/jats:p>","DOI":"10.1055\/a-2968-5875","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:06:00Z","timestamp":1790723160000},"source":"Crossref","is-referenced-by-count":0,"title":["Nomogram for Poor 3-Month Functional Recovery After Total Knee Arthroplasty Using Cartilage Damage and Synovial Fluid Biomarkers: Development and Internal Evaluation"],"prefix":"10.1055","author":[{"given":"Jiaxiang","family":"Li","sequence":"first","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongyuan","family":"Hong","sequence":"first","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengling","family":"Gong","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaidong","family":"Deng","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongqiang","family":"Huang","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Traditional Chinese Medicine, Guangdong Province, China","place":["Dongguan"],"department":["Orthopedics Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"104006","DOI":"10.1016\/j.otsr.2024.104006","article-title":"Knee arthroplasty: an international systemic review of epidemiological trends","volume":"111","author":"M Le Stum","year":"2025","journal-title":"Orthop Traumatol Surg Res"},{"issue":"17","key":"ref2","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"M Sloan","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"3150","DOI":"10.3390\/jcm9103150","article-title":"Patient-reported outcomes following total knee replacement in patients <65 years of age-a systematic review and meta-analysis","volume":"9","author":"J Trieu","year":"2020","journal-title":"J Clin Med"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.arth.2024.09.039","article-title":"Predicting outcome of total knee arthroplasty by cluster analysis of patient-reported outcome measures","volume":"40","author":"J L Littman","year":"2025","journal-title":"J Arthroplasty"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1016\/j.arth.2020.10.053","article-title":"Clinical decision support tools for predicting outcomes in patients undergoing total knee arthroplasty: a systematic review","volume":"36","author":"J A Cochrane","year":"2021","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1186\/s13018-020-01854-9","article-title":"Patient and surgical prognostic factors for inpatient functional recovery following THA and TKA: a prospective cohort study","volume":"15","author":"N A Hewlett-Smith","year":"2020","journal-title":"J Orthop Surg Res"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1302\/2046-3758.49.2000417","article-title":"Predicting early clinical function after hip or knee arthroplasty","volume":"4","author":"S Poitras","year":"2015","journal-title":"Bone Joint Res"},{"key":"ref8","first-page":"8293921","article-title":"The role of inflammation in the pathogenesis of osteoarthritis","volume":"2020","author":"Y Y Chow","year":"2020","journal-title":"Mediators Inflamm"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5606\/ArchRheumatol.2017.6220","article-title":"Cartilage oligomeric matrix protein levels in synovial fluid in patients with primary knee osteoarthritis and healthy controls: a preliminary comparative analysis with serum cartilage oligomeric matrix protein","volume":"32","author":"R D Arellano","year":"2017","journal-title":"Arch Rheumatol"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1080\/17453674.2021.1925412","article-title":"Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients","volume":"92","author":"J C Van Egmond","year":"2021","journal-title":"Acta Orthop"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.arth.2017.11.051","article-title":"Understanding the relationship between 3-month and 2-year pain and function scores after total knee arthroplasty for osteoarthritis","volume":"33","author":"R Gandhi","year":"2018","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1007\/s11999-016-4732-4","article-title":"Classifications in brief: Kellgren-Lawrence classification of osteoarthritis","volume":"474","author":"M D Kohn","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"ref13","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"N Bellamy","year":"1988","journal-title":"J Rheumatol"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1302\/0301-620X.105B7.BJJ-2022-0989.R1","article-title":"Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification","volume":"105-B","author":"V Lu","year":"2023","journal-title":"Bone Joint J"},{"issue":"9823","key":"ref15","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0140-6736(11)60752-6","article-title":"Knee replacement","volume":"379","author":"A J Carr","year":"2012","journal-title":"Lancet"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"P Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1002\/art.42819","article-title":"Using two predictive models to capture two types of poor outcomes in knee arthroplasty: a multisite longitudinal cohort study","volume":"76","author":"D L Riddle","year":"2024","journal-title":"Arthritis Rheumatol"},{"issue":"13","key":"ref18","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1080\/09638288.2022.2084776","article-title":"The Western Ontario and McMaster Universities Osteoarthritis, Lequesne Algofunctional index, Arthritis Impact Measurement Scale-short form, and Visual Analogue Scale in patients with knee osteoarthritis: responsiveness and minimal clinically important differences","volume":"45","author":"R Salehi","year":"2023","journal-title":"Disabil Rehabil"},{"key":"ref19","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","author":"World Health Organization","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"ref20","volume-title":"2020\u20132025 Dietary Guidelines for Americans","author":"U.S. Department of Health and Human Services","year":"2020","edition":"9th ed."},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"M E Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"J H Kellgren","year":"1957","journal-title":"Ann Rheum Dis"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"A S Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref24","first-page":"35","article-title":"Preoperative determinants of patient satisfaction following total knee arthroplasty: a systematic review","volume":"8","author":"E Lungu","year":"2014","journal-title":"Open Orthop J"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.artd.2021.03.013","article-title":"Predictive models for clinical outcomes in total knee arthroplasty: a systematic analysis","volume":"9","author":"C Batailler","year":"2021","journal-title":"Arthroplast Today"},{"issue":"744","key":"ref26","doi-asserted-by":"crossref","first-page":"eabn7082","DOI":"10.1126\/scisignal.abn7082","article-title":"Interleukin-6 signaling mediates cartilage degradation and pain in posttraumatic osteoarthritis in a sex-specific manner","volume":"15","author":"Y Liao","year":"2022","journal-title":"Sci Signal"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/BOR.0000000000000923","article-title":"Inflammation in osteoarthritis: the latest progress and ongoing challenges","volume":"35","author":"A J Knights","year":"2023","journal-title":"Curr Opin Rheumatol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.bbi.2024.06.001","article-title":"The association between changes in clinical pain severity and IL-6 reactivity among patients undergoing total knee arthroplasty: the moderating role of change in insomnia","volume":"120","author":"J M Wilson","year":"2024","journal-title":"Brain Behav Immun"},{"issue":"18","key":"ref29","doi-asserted-by":"crossref","first-page":"9182","DOI":"10.3390\/ijms26189182","article-title":"COMP is a biomarker of cartilage destruction, extracellular matrix and vascular remodeling and tissue repair","volume":"26","author":"M M Smith","year":"2025","journal-title":"Int J Mol Sci"},{"issue":"06","key":"ref30","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1302\/2046-3758.136.BJR-2023-0180.R1","article-title":"Cartilage oligomeric matrix protein as a potential biomarker for knee osteoarthritis","volume":"13","author":"W Udomsinprasert","year":"2024","journal-title":"Bone Joint Res"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1584238","DOI":"10.3389\/fsurg.2025.1584238","article-title":"Meta-analysis of prognostic factors in patients with knee arthroplasty","volume":"12","author":"F Guo","year":"2025","journal-title":"Front Surg"},{"issue":"07","key":"ref32","first-page":"e88391","article-title":"Obesity predicts longer operative time and worse functional recovery after total knee arthroplasty under enhanced recovery protocols in asian patients","volume":"17","author":"R Radhakrishnan","year":"2025","journal-title":"Cureus"},{"issue":"10","key":"ref33","doi-asserted-by":"crossref","first-page":"3107","DOI":"10.1097\/JS9.0000000000000563","article-title":"Prediction of early functional outcomes in patients after robotic-assisted total knee arthroplasty: a nomogram prediction model","volume":"109","author":"X Duan","year":"2023","journal-title":"Int J Surg"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1427768","DOI":"10.3389\/fmed.2024.1427768","article-title":"Influencing factors on the quality of recovery after total knee arthroplasty: development of a predictive model","volume":"11","author":"S Shan","year":"2024","journal-title":"Front Med (Lausanne)"},{"issue":"31","key":"ref35","doi-asserted-by":"crossref","first-page":"e43657","DOI":"10.1097\/MD.0000000000043657","article-title":"Construction and validation of a nomogram prediction model for chronic pain after total knee arthroplasty","volume":"104","author":"X M Li","year":"2025","journal-title":"Medicine (Baltimore)"},{"issue":"11","key":"ref36","first-page":"2325967124S00483","article-title":"Validation of risk stratification protocol for total knee arthroplasty","volume":"12","author":"F B Loures","year":"2024","journal-title":"Orthop J Sports Med"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s43019-025-00295-0","article-title":"Artificial intelligence in total knee arthroplasty: clinical applications and implications","volume":"37","author":"K B Kim","year":"2025","journal-title":"Knee Surg Relat Res"},{"issue":"07","key":"ref38","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.3390\/biomedicines13071644","article-title":"Knee osteoarthritis diagnosis: future and perspectives","volume":"13","author":"H Favreau","year":"2025","journal-title":"Biomedicines"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s42836-023-00204-4","article-title":"Advances in the application of wearable sensors for gait analysis after total knee arthroplasty: a systematic review","volume":"5","author":"Y Feng","year":"2023","journal-title":"Arthroplasty"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2968-5875.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:15:06Z","timestamp":1792192506000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2968-5875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":39,"URL":"https:\/\/doi.org\/10.1055\/a-2968-5875","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9,29]]},"published":{"date-parts":[[2026,9,29]]}}}