Postoperative symptom cluster classification and its association with health-related quality of life in knee osteoarthritis patients after total knee arthroplasty: An observational study

Total knee arthroplasty (TKA) is an effective surgical treatment for advanced knee osteoarthritis (KOA). However, the classification of postoperative symptom clusters and their impact on quality of life (QoL) remain underexplored. This study aims to categorize symptom clusters in KOA patients after TKA using latent class analysis (LCA) and to analyze the relationship between symptom clusters and QoL. Standardized questionnaires were used to assess postoperative symptoms, including pain, swelling, anxiety, depression, and sleep disorders. LCA was employed to classify patients into high-symptom (C1), low-symptom (C2), and high-swelling (C3) groups. Multivariate unordered multinomial logistic regression was applied to analyze the association between symptom clusters and clinical variables. Differences in SF-12 health survey total scores and dimensional scores among symptom clusters were also compared. A total of 365 KOA patients who underwent TKA were analyzed (from 389 valid respondents; valid response rate 93.8%). LCA identified 3 distinct symptom clusters: C1 (high-symptom group, n = 59; 16.2%), C2 (low-symptom group, n = 186; 51.0%), and C3 (high-swelling group, n = 120; 32.9%). Key factors differentiating the high-symptom group from the low-symptom group included BMI, first joint surgery, and swelling severity (P < .05). On the SF-12, the total score of C1 (50.38 ± 12.96) was significantly lower than that of C2 (56.63 ± 9.56, P = .003) and C3 (57.42 ± 10.85, P = .004). The mental dimension score was significantly lower in C1 (55.22 ± 13.72) than in C2 (63.17 ± 11.33, P < .001) and C3 (63.61 ± 12.23, P < .001). Postoperative symptom cluster classification is an effective tool for assessing the symptom profile of KOA patients after TKA. Significant differences in QoL were found across symptom clusters, with the high-symptom and high-swelling groups showing lower quality of life, particularly in mental health. This study provides data support for individualized management of postoperative symptoms in KOA patients, highlighting the importance of comprehensive symptom assessment in postoperative care.