Adjusted Survival Curves Improve Understanding of Multivariable Cox Model Results

Carly S. Lundgreen, Dirk R. Larson, Elizabeth J. Atkinson, Katrina L. Devick, David G. Lewallen, Daniel J. Berry, Hilal Maradit Kremers, Cynthia S. Crowson

Research output: Contribution to journalArticlepeer-review


Kaplan-Meier survival curves are the most common methods for unadjusted group comparison of outcomes in orthopedic research. However, they may be misleading due to an imbalance of confounders between patient groups. The Cox model is frequently used to adjust for confounders, but graphical display of adjusted survival curves is not commonly utilized. We describe the circumstances when adjusted survival curves are useful in orthopedic research, describe and use 2 different methods to obtain adjusted curves, and illustrate how they can improve understanding of the multivariable Cox model results. We further provide practical strategies for identifying the need for and performing adjusted survival curves. Please visit the following for a video that explains the highlights of the paper in practical terms.

Original languageEnglish (US)
Pages (from-to)3367-3371
Number of pages5
JournalJournal of Arthroplasty
Issue number10
StatePublished - Oct 2021


  • Cox model
  • confounding
  • survival analysis
  • survival curves
  • total joint arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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