Impact of the COVID-19 Pandemic on Post-Operative Convalescence After Total Knee Arthroplasty

Abstract

The COVID-19 pandemic disrupted rehabilitation services nationwide, potentially affecting recovery following total knee arthroplasty (TKA). Using PEPPER Trial data (n = 4,342 across 34 U.S. sites), this study examined changes in physical therapy utilization, length of stay, adverse events, and PROM-based recovery before and after the onset of the pandemic. Preliminary findings from the primary analytic cohort (10 sites, n = 2,842) indicate a meaningful decline in formal physical therapy engagement at 1, 3, and 6 months post-TKA following March 2020. Early analysis of KOOS Jr. and discharge disposition suggests shifts in recovery trends, though patient-level and site-level heterogeneity remain significant. Strengths include standardized multi-institutional follow-up and robust PROM collection; limitations include potential misclassification of tele-rehabilitation and residual confounding. Ongoing mixed-effects modeling will clarify the pandemic’s impact on postoperative recovery patterns and inform future strategies for maintaining rehabilitation access.