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Open Access Research article

Income and patient-reported outcomes (PROs) after primary total knee arthroplasty

Jasvinder A Singh123* and David G Lewallen3

Author affiliations

1 Medicine Service and Center for Surgical Medical Acute are Research and Transitions (C-SMART), Birmingham VA Medical Center, 700 19th Street South Birmingham, AL 35233, USA

2 Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 20th Street South, FOT 805B, Birmingham, AL 35294, USA

3 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA

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Citation and License

BMC Medicine 2013, 11:62  doi:10.1186/1741-7015-11-62

Published: 6 March 2013



To assess whether income is associated with patient-reported outcomes (PROs) after primary total knee arthroplasty (TKA).


We used prospectively collected data from the Mayo Clinic Total Joint Registry to assess the association of income with index knee functional improvement, moderate to severe pain and moderate to severe activity limitation at 2-year and 5-year follow-up after primary TKA using multivariable-adjusted logistic regression analyses.


There were 7, 139 primary TKAs at 2 years and 4, 234 at 5 years. In multivariable-adjusted analyses, at 2-year follow-up, compared to income > US$45, 000, lower incomes of ≤ US$35, 000 and > US$35, 000 to 45, 000 were associated (1) significantly with moderate to severe pain with an odds ratio (OR) 0.61 (95% CI 0.40 to 0.94) (P = 0.02) and 0.68 (95% CI 0.49 to 0.94) (P = 0.02); and (2) trended towards significance for moderate to severe activity limitation with OR 0.78 (95% CI 0.60 to 1.02) (P = 0.07) and no significant association with OR 0.96 (95% CI 0.78 to 1.20) (P = 0.75), respectively. At 5 years, odds were not statistically significantly different by income, although numerically they favored lower income. In multivariable-adjusted analyses, overall improvement in knee function was rated as 'better' slightly more often at 2 years by patients with income in the ≤ US$35, 000 range compared to patients with income > US$45, 000, with an OR 1.9 (95% CI 1.0 to 3.6) (P = 0.06).


We found that patients with lower income had better pain outcomes compared to patients with higher income. There was more improvement in knee function, and a trend towards less overall activity limitation after primary TKA in lower income patients compared to those with higher incomes. Insights into mediators of these relationships need to be investigated to understand how income influences outcomes after TKA.

arthroplasty; income; joint replacement; patient-reported outcomes; risk factor; total knee replacement