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      Patient Satisfaction after Total Knee Arthroplasty

      review-article
      , MD, , MD
      Knee Surgery & Related Research
      The Korean Knee Society
      Knee, Osteoarthritis, Arthroplasty, Satisfaction

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          Abstract

          Total knee arthroplasty (TKA) is one of the most successful and effective surgical options to reduce pain and restore function for patients with severe osteoarthritis. The purpose of this article was to review and summarize the recent literatures regarding patient satisfaction after TKA and to analyze the various factors associated with patient dissatisfaction after TKA. Patient satisfaction is one of the many patient-reported outcome measures (PROMs). Patient satisfaction can be evaluated from two categories, determinants of satisfaction and components of satisfaction. The former have been described as all of the patient-related factors including age, gender, personality, patient expectations, medical and psychiatric comorbidity, patient's diagnosis leading to TKA and severity of arthropathy. The latter are all of the processes and technical aspects of TKA, ranging from the anesthetic and surgical factors, type of implants and postoperative rehabilitations. The surgeon- and patient-reported outcomes have been shown to be disparate occasionally. Among various factors that contribute to patient satisfaction, some factors can be managed by the surgeon, which should be improved through continuous research. Furthermore, extensive discussion and explanation before surgery will reduce patient dissatisfaction after TKA.

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          Most cited references47

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          The MOS short-form general health survey. Reliability and validity in a patient population.

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            The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty.

            Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was to determine which factors contribute to patient satisfaction with total knee replacement (TKR), and their relative importance. At a minimum of 1 year post unilateral primary TKR, 253 patients completed a self-administered, validated "Knee Function Questionnaire," which examined each patient's participation in a broad range of activities involving the knee, their level of satisfaction, and the extent to which TKR had fulfilled their expectations. The association between function, expectation and satisfaction was examined using univariate and multivariate logistic regression. Seventy-five percent of patients were either "satisfied" or "very satisfied" with their knee replacement, while 14% were "dissatisfied" or "very dissatisfied." Satisfaction correlated significantly (p < 0.001) with age less than 60, absence of residual symptoms, fulfillment of expectations, and absence of functional impairment. Satisfaction with TKR is primarily determined by patients' expectations, and not their absolute level of function. Real improvements in the outcome of TKA must address prevention of residual pain, stiffness and swelling, and each patient's preoperative concept of the likely outcome of these procedures.
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              Questionnaire on the perceptions of patients about total knee replacement.

              We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36. Some also filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon completed the American Knee Society (AKS) clinical score. The single score derived from the new questionnaire had high internal consistency, and its reproducibility, examined by test-retest reliability, was found to be satisfactory. Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. We also compared change in scores with the patients' retrospective judgement of change in their condition. The effect size for the new questionnaire compared favourably with those for the relevant parts of the SF36. The change scores for the new knee questionnaire were significantly greater (p < 0.0001) for patients who reported the most improvement in their condition. The new questionnaire provides a measure of outcome for TKR that is short, practical, reliable, valid and sensitive to clinically important changes over time.
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                Author and article information

                Journal
                Knee Surg Relat Res
                Knee Surg Relat Res
                KSRR
                Knee Surgery & Related Research
                The Korean Knee Society
                2234-0726
                2234-2451
                March 2016
                29 February 2016
                : 28
                : 1
                : 1-15
                Affiliations
                Department of Orthopedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea.
                Author notes
                Correspondence to: Ho Jong Ra, MD. Department of Orthopedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, 38 Bangdong-gil, Gangneung, 25440, Korea. Tel: +82-33-610-3244, Fax: +82-33-641-8050, os_rahj@ 123456naver.com
                Article
                10.5792/ksrr.2016.28.1.1
                4779800
                26955608
                0cb57f20-97dd-458a-aea9-ece16d277c6a
                Copyright © 2016 KOREAN KNEE SOCIETY

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 April 2015
                : 12 August 2015
                : 12 September 2015
                Categories
                Review Article

                Surgery
                knee,osteoarthritis,arthroplasty,satisfaction
                Surgery
                knee, osteoarthritis, arthroplasty, satisfaction

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