Are Currently Available Joint-Specific Patient-Reported Outcome Measures Fit for Purpose to Assess the Outcome of Knee Arthroplasty?

Patient-reported outcome measures (PROMs) are integral to assessing patient function, quality of life, and pain both before and after knee arthroplasty (KA). Given the frequently excellent outcomes associated with KA, meaningful comparisons between patient cohorts or interventions require validated, precise PROMs that reliably reflect patient priorities and satisfaction. However, patients undergoing KA today have different demographic characteristics, different expectations, and different outcomes from those for whom these metrics were originally designed. Given changing lifestyles, many items in legacy PROMs may no longer represent priorities for patients in their postoperative recovery, and current evidence suggests that many are not associated with patient satisfaction. The frequent ceiling effects observed in PROMs for some subgroups following KA limit their reliability and utility in assessing outcomes for high-functioning patients. Whilst combining multiple PROM tools can provide a better, more holistic overview of patient outcome, it carries with it a significant burden and feasibility restriction. Item response theory and computerised adaptive testing present opportunities to collect PROMs from patients in a convenient manner and minimise question burden. Contemporary PROM collection requires both these innovative collection tools and analytic techniques, and questions that reliably reflect the priorities of the modern-day patient undergoing KA.