Multivariate Profiling of Physical Resilience in Older Adults After Total Knee Replacement Surgery

IMPORTANCEAs individuals age, they often face a variety of health challenges. Physical resilience indicates how well a person can cope with and recover from physical challenges, which is crucial for maintaining independence and quality of life in older age. OBJECTIVETo develop a multivariate phenotype of physical resilience based on individual recovery dynamics before and after a clinical stressor. DESIGN, SETTING, AND PARTICIPANTSThis observational study included 112 individuals aged 60 and older who underwent elective total knee replacement for degenerative joint disease between December 2, 2019, and January 4, 2023. Physical function was assessed before surgery and at 1, 6, and 12 months post-surgery to characterize resilience trajectories. EXPOSUREElective total knee replacement surgery for degenerative joint disease. MAIN OUTCOMES AND MEASURESA multivariate resilience phenotype was derived from physical function trajectories assessed using the Short Physical Performance Battery, the Pittsburgh Fatigability Scale-Physical Subscale, the KOOS Quality of Life, and the SF36-Physical Component Score. This phenotype was validated against surrogate markers (i.e., frailty, self-reported health) and determinants (e.g., the Charlson Comorbidity Index) of recovery potential (aka resilience capacity). RESULTSThe study identified distinct resilience profiles across four measures: 4 profiles for the Short Physical Performance Battery and the KOOS Quality of Life, 3 each for the Pittsburgh Fatigability Scale-Physical Subscale and the SF36-Physical Component Score, showing varied baseline levels and/or change rates over 12 months. By combining and analyzing resilience profiles across measures, two distinct groups emerged: 35.7% classified as non-resilient and 64.3% as resilient. The non-resilient group had a higher prevalence of frailty (35.0% vs. 9.7%, p<0.01), poor or fair self-reported health (45.0% vs. 5.6%, p<0.01), and a moderate/severe comorbidity burden (Charlson Comorbidity Index >2; 27.5% vs. 11.1%, p=0.06). CONCLUSIONS AND RELEVANCEThe distinct recovery trajectories observed after the surgery indicated varying resilience levels that were not fully explained by baseline status. This research underscores the importance of resilience in surgical recovery and could pave the way for better patient care by focusing on individual resilience capacities and shifting the focus from managing health conditions to promoting recovery and overall well-being. Key PointsO_ST_ABSQuestionC_ST_ABSCan recovery trajectories of physical function following total knee replacement surgery serve as indicators of resilience to physical stressors? FindingsAn observational study of adults aged 60+ undergoing elective total knee replacement surgery found distinct 12-month recovery paths, with 35.7% classified as non-resilient and 64.3% as resilient, independent of pre-surgery health or fitness. MeaningThis finding suggests that resilience is measurable and may require dynamic testing, rather than just relying on baseline health, to assess recovery potential.