Each year, 700,000 patients undergo total knee arthroplasty(1). The financial cost of these total knee arthroplasty surgeries on both a patient and societal level have been well defined(2). In an attempt to identify patient factors affecting outcomes and ascertain any potential association with these factors and cost, arthroplasty literature has expanded in this area. Recent research has begun to clearly identify non-patient modifiable risk factors as well as modifiable factors that have significant effect on patient outcomes(3). There remains a paucity of literature as it relates to social support, more specifically marital status, and its effect on TKA outcomes. Meanwhile, literature in medical subspecialties continues to define the effect a spouse has on outcomes in various different disease processes. In cohort of patients with heart disease, married status has been linked to a faster recovery from cardiac surgery, less psychological distress, and higher rates of survival following a cardiac event(4). Also, there has been a clear association defined between marital status and increased survival rates in cohorts with various types of cancers(5). A recent summit convened by American Association of Hip and Knee Surgeons (AAHKS), listed marital status on “Future Desired List of Risk Variables”(6). This designation illustrates the importance that AAHKS has placed on understanding what effect, if any, marital status may have on patient outcomes. The purpose of this article is to assess whether a patient’s marital status had significant influence on the outcomes after total knee arthroplasty at follow up to six months. Our hypothesis is that a married status would be associated with significantly better outcomes throughout the period of follow up. Does Marital Status Impact Outcomes Following Total Knee Arthroplasty? Does Marital Status Impact Outcomes Following Total Knee Arthroplasty? Luke Townsend BS; Ryan Roubion BS; Grant Pollock BS; Devin Bourgieos BS; Claudia Leonardi PhD; Rabun Fox MD; Vinod Dasa MD LSUHSC Department of Orthopedics Abstract. Background: There is a paucity of research on the relationship between marital status and patient outcomes following total knee arthroplasty (TKA). Methods: This was a retrospective chart review of patients who underwent TKA by a single surgeon at a university-based orthopedic practice. Data abstracted included age, gender, marital status, body mass index (BMI), length of hospital stay (LOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Knee Score (OKS). The WOMAC and OKS were administered at the pre-operative visit and at approximately 10, 30, 90 and 180 days following TKA. Multivariate analyses with patient-reported outcomes (PROs) as repeated measures, marital status, day of assessment, and the interaction of marital status and day of assessment as fixed effects, and age, gender, BMI, and LOS as covariates were conducted as well as analyses in which pre-operative PROs were treated as fixed effects. Results: Of 422 patients who underwent TKA during the study period, complete data were available for 249, of whom 124 were married and 125 unmarried. Married patients had significantly higher WOMAC scores than unmarried patients at all post-operative assessments, even after controlling for pre-operative scores. Although married patients also had significantly higher post-operative OKS scores than their unmarried peers, differences between groups were attenuated after adjusting for pre-operative OKS scores. Conclusion: This study found that married patients have better overall outcomes following TKA, but yielded conflicting results as to whether the positive effects of marriage are specific to the post-operative period. Patient Demographics Oxford Scores Introduction Post-operative Scores WOMAC Scores Conclusions Table 1. Participant characteristics by marital status 1 Post-operative scores include assessments completed at post-operative days 10, 30, 90, and Fixed effects included pre-operative score, age, gender, body mass index, and length of hospital stay as covariates. 3 Values are least square means. UNM = unmarried; M = married; MS = marital status; SEM = standard error of the mean. Figure 1. WOMAC scores least square means for married (black line) and unmarried (grey line) patients collected pre-operative and post-operative at 10, 30, 90, and 180 days. Means within each time point with superscript significantly differed between married and unmarried (*P <0.05; ** P <0.01; *** P <0.001). References Figure 2. Overall Oxford Knee score least square means for married (black line) and unmarried (grey line) patients collected pre-operative and post-operative at 10, 30, 90, and 180 days. Means within each time point with superscript significantly differed between married and unmarried (*P <0.05; ** P <0.01; *** P <0.001). 1. Peter Cram, M. M., Xin Lu, M., Kates, S. L., Jasvinder A. Singh, M. M., Yue Li, P., & Brian R. Wolf, M. M. (2012). Total Knee Arthroplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries, Journal of the American Medical Association, Bedair H, Cha TD, Hansen VJ. Economic benefit to society at large of total knee arthroplasty in younger patients: a Markov analysis. J Bone Joint Surg Am Jan 15;96(2): Israel M. Barbash, MD, Michael A. Gaglia, Jr., MD, Rebecca Torguson, MPH, Sa'ar Minha, MD, Lowell F. Satler, MD, Augusto D. Pichard, MD, and Ron Waksman, MD Washington, DC. Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization. American Heart Journal. 4. Khan, C. I. (February 2009). Spousal Suport Following Knee Surgery: Roles of Self-efficacy and Perceived Emotional Repsponsiveness. Rehabilitation Psychology, Fekete EM, S. M. (June 2006). Effects of Spousal Control and Support on Older Adults' Recovery From Knee Surgery.Journal of Family Psychology, Franks, M. S. (June 2006). Spouses' Provision of Health-related Support and Control to Patients Participating in Cardiac Rehabilitation. Journal of Family Psychology, Ayal A. Aizer, M.-H. C. (2013). Marital Status and Survival Patients With Cancer. Journal of Clinical Oncology, Leiberman JR, Teuscher D, Berry DJ, Vail TP. Re: Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. A Joint Communication From the American Association of Orthopaedic Surgeons, The American Joint Replacement Registry, The Hip Society, The Knee Society, and The American Association of Hip and Knee Surgeons Sep Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Mirza S, Weinstein J. Who should have surgery for an intervertebral disc herniation? Comparative effectiveness evidence from SPORT. Spine (Phila Pa 1976) Table 1. Post-operative WOMAC, Overall, pain, and function Oxford scores by marital status.