Heart failure patients demonstrate excellent 1-year outcomes after total knee arthroplasty despite high healthcare utilization

Purpose Many heart failure (HF) patients undergo total knee arthroplasty (TKA), but their postoperative outcomes remain unclear. This study aimed to compare healthcare resource utilization and patient-reported outcome measures (PROMs) after TKA between patients with and without HF. Methods A retrospective analysis of 12,491 TKA at our institution from 2016 to 2021, including 495 with HF. HF patients were stratified into three ejection fraction (EF) categories: preserved (≥ 50%, n = 374), mildly reduced (41–49%, n = 53), and reduced (≤ 40%, n = 68). Healthcare utilization metrics and 1-year mortality were compared. PROMs were assessed using the Knee Injury and Osteoarthritis Outcome Score for Pain (KOOS-Pain), Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR) at baseline and 1-year postoperatively. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds were evaluated. Results HF patients had significantly higher odds of prolonged hospital stay (OR 2.55, p < 0.001), non-home discharge (OR 2.17, p < 0.001), 90-day readmission (OR 2.02, p < 0.001), 90-day emergency department visits (OR 1.55, p = 0.002), and 1-year mortality (OR 3.53, p = 0.007). PROMs were similar between HF and non-HF patients at 1 year, though HF patients were more likely to achieve MCID for KOOS-PS ( p = 0.021). Among EF subgroups, patients with mildly reduced EF had significantly higher 1-year KOOS-Pain ( p = 0.024) and PASS achievement for pain ( p = 0.043). EF did not predict 1-year outcomes. Conclusion Despite increased healthcare utilization, HF patients undergoing TKA achieve similar improvements in pain and functionality as non-HF patients. HF severity was not associated with differential healthcare utilization, suggesting that risk stratification based on HF severity may not be necessary. Level of evidence III.