A new prediction model for patient satisfaction after total knee arthroplasty and the roles of different scoring systems: a retrospective cohort study

Abstract

Background Although total knee arthroplasty (TKA) is an efficacious treatment for end-stage osteoarthritis, ~20% of patients are dissatisfied with the results. We determined which factors contribute to patient satisfaction and compared the various scoring systems before and after surgery. Methods In this retrospective cohort study, 545 patients were enrolled and evaluated preoperatively and 1 year postoperatively. Patient demographics, as well as scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-12, and 1989 Knee Society Clinical Rating System (1989 KSS), were recorded preoperatively and postoperatively. The possible predictors were introduced into a prediction model. Scores for overall satisfaction and the 2011 Knee Society Score (2011 KSS) were also assessed after TKA to identify the accuracy and agreement of the systems. Results There were 134 male patients and 411 female patients, with an overall prevalence of satisfaction of 83.7% 1 year after surgery. A history of surgery (p < 0.001) and the 1989 KSS and SF-12 were of the utmost importance in the prediction model, whereas the WOMAC score had a vital role postoperatively (change in WOMAC pain score, p < 0.001; change in WOMAC physical function score, p < 0.001; postoperative WOMAC pain score, p = 0.004). C-index of model was 0.898 > 0.70 (95% confidence interval (CI): 0.86-0.94). The Hosmer-Lemeshow test showed a p value of 0.586, and the AUC of external cohort was 0.953 (sensitivity=0.87, specificity=0.97). The agreement between the assessment of overall satisfaction and the 2011 KSS satisfaction assessment was general (Kappa=0.437 > 0.4, p < 0.001). Conclusion A history of surgery, the preoperative 1989 KSS, and the preoperative SF-12 influenced patient satisfaction after primary TKA. We recommend the WOMAC (particularly the pain subscale score) to reflect overall patient satisfaction postoperatively.

Distribution of Coronal Plane Alignment of the Knee Classification in Patients with Knee Osteoarthritis in Japan

“…However, patient dissatisfaction rates of up to 20% after conventional TKA have been reported in the literature. [6][7][8] Although the reasons for patient dissatisfaction are multifactorial, a potential cause may include changes in limb alignment. 9 Normal limb alignment varies widely between individuals with a substantial percentage of the population having native constitutional varus knee.…”

Patient Demographic Factors Impact KOOS JR Response Rates for Total Knee Arthroplasty Patients

“…1,2 Despite the longevity of total knee arthroplasty (TKA) implants, between 10 and 20% of TKA patients remain dissatisfied with their experience and outcomes. [3][4][5] Patient-reported outcome measures (PROMs) play a vital role in evaluating patient outcomes and will become increasingly important for the determination of hospital reimbursement over the next 5 years. 2,6 PROMs have distinct advantages compared with objective measurements.…”

Capability After Total Knee Arthroplasty for Osteoarthritis Is Strongly Associated With Preoperative Symptoms of Depression

“…4,5 Although more than 80% of patients undergoing TKA report notable improvements in capability and comfort, [6][7][8][9] many studies also show that up to 20% are categorically dissatisfied with their outcomes a year or more after surgery. 7,[9][10][11][12][13][14] This not only signals the importance of addressing a patient's hopes and concerns during shared decision making for TKA but also signals the importance of addressing common personal factors and aspects of mental health, such as depressive symptoms, in the management of knee OA. 15 Patient-reported outcome measures of capability and surveys measuring pain intensity and aspects of mental health can help better understand the relationship between these factors.…”