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Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study. [Dataset]


David J. Mclernon
Data Collector

David Hamilton
Data Collector

Hamish A. Simpson
Data Collector

Marcus Beasley
Data Collector

Gary J. Macfarlane
Data Collector


Objectives: The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods: This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results: Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months. Key predictors were poor clinical status, widespread body pain, high expectation of postoperative pain and lack of active coping. The developed model based on these variables demonstrated good discrimination. At the optimal cut-off, the final model had a sensitivity of 83%, specificity of 61% and positive likelihood ratio of 2.11. Excellent agreement was found between observed and predicted outcomes, and there was no evidence of overfitting in the model. Conclusion: We have developed and validated a clinical prediction model that can be used to identify patients at high risk of a poor outcome after TKA. This clinical risk score may be an aid to shared decision-making between patient and clinician. The file accompanying this output contains supplementary tables.


SHIM, J., MCLERNON, D.J., HAMILTON, D., SIMPSON, H.A., BEASLEY, M. and MACFARLANE, G.J. 2018. Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study. [Dataset]. Rheumatology advances in practice [online], 2(2), article rky021. Available from:

Acceptance Date Apr 27, 2018
Online Publication Date May 29, 2018
Publication Date Dec 31, 2018
Deposit Date Oct 14, 2021
Publicly Available Date Oct 14, 2021
Publisher Oxford University Press
Keywords Knee pain; Osteoarthritis; Total knee arthroplasty; Prediction modelling; Clinical risk score; Model calibration; Model discrimination
Public URL
Related Public URLs
Type of Data Supplementary tables.
Collection Date Jul 31, 2016
Collection Method The study recruited from nine participating centres across the UK between December 2013 and July 2016. The study was conducted alongside a randomized controlled trial of targeted rehabilitation to improve outcome after TKA. Adults aged ≥16 years, undergoing primary TKA for OA, were invited to take part in the study either by letter or in person at a clinic visit before surgery. Participants were excluded if they: were undergoing a revision TKA or fully constrained knee arthroplasty; had a TKA for a diagnosis other than OA; or had existing medical conditions, such as stroke, or other musculoskeletal conditions that cause a limitation of function. Participants completed a questionnaire at the time of recruitment, and consent was obtained for access to medical records for research purposes. Follow-up questionnaires were posted to participants 6 weeks, 3 and 6 months after surgery.