Anterior knee pain and sit‐up tests predicts patients’ satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing

Abstract

Purpose The purpose of this study was to assess patient satisfaction and identify risk factors for dissatisfaction after anterior stabilised conventional total knee arthroplasty (TKA) without patellar resurfacing, using the Goodman score. Methods We conducted a cross-sectional study using data from our institutional database from 1 January 2018 to 1 March 2021. Patients who underwent TKA with the Vanguard® Cruciate Retaining Anterior Stabilized Knee System (Zimmer Biomet, Warsaw, Indiana, USA) without patellar replacement were included. Patients with other bearing surfaces (posterior stabilised or medial congruent) or diagnosed with infection or instability were excluded. Patients' reported outcomes, body mass index (BMI), passive range of motion, the timed up-and-go test, sit-up test, and algometry were assessed. Patients were also asked if they had anterior knee pain. Satisfaction was assessed using the Goodman scale, and logistic multivariate regression was used to identify variables associated with dissatisfaction and perceived improvement in quality of life. Results A total of 131 TKA patients were included in the study. The median satisfaction score was 100 (interquartile range [IQR], 87.5 to 100), with the 75-point threshold at the 90th percentile according to Section A of Goodman. Section B of Goodman showed that 113 TKA patients (86.26%) reported "great improvement" or "more than I ever dreamed." Multivariate logistic regression revealed that anterior knee pain (OR 5.16, 95% CI 1.24 to 21.39), the sit-up test (OR 0.63, 95% CI 0.49 to 0.81), and BMI (OR 0.84, 95% CI 0.70 to 0.99) were significantly associated with patient dissatisfaction and a worse perceived improvement in quality of life. The receiver operating characteristics curve for the models had areas under the curve of 0.83 (95% CI 0.69 to 0.97) and 0.82 (95% CI 0.70 to 0.94), respectively. Conclusion Anterior stabilised TKA without patellar resurfacing can achieve 90% satisfaction and 86% improvement in quality of life. To improve these results, it is essential to prevent and treat anterior knee pain and enhance quadriceps strength. Level of evidence Level III (retrospective cohort study).

Similar Patient Satisfaction and Quality of Life Improvement Achieved with TKA and THA According to the Goodman Scale: A Comparative Study

“…In addition, although the cohort of patients with THA had a shorter follow-up period in this study, Schmitz et al’s indicated that satisfaction with this surgery does not diminish with longer follow-ups [ 21 ]. While female patients have been reported to be at a higher risk of developing chronic pain and dissatisfaction after TKA [ 22 ], our previous study and the meta-analysis conducted by DeFrance et al showed no difference in satisfaction rates by gender [ 5 , 9 ]. Furthermore, the development of chronic pain has been associated with managing perioperative pain, sleep disorders, personality traits, and psychiatric disorders such as anxiety rather than being solely linked to gender [ 23 , 24 , 25 ].…”

“…In its Spanish validation, a similar correlation was noted with the OHS [ 7 ]. Moreover, in knee patients, the KUJALA, KOOS quality of life, and WOMAC scales can predict the Goodman score, yielding an area under the ROC curve of 0.82 (95% CI: 0.70 to 0.94) [ 9 ]. Furthermore, Ulivi et al [ 10 ] identified a moderate-to-strong correlation between the Goodman score and both EQ-5D and SF-12.…”

“…This study is an observational design that compares two previously published cohorts of patients who underwent THA and TKA in the same university hospital. The THA cohort included patients who underwent conventional uncemented primary hip replacement for hip osteoarthritis between 2018 and 2019 [ 7 ], while the TKA cohort included patients who underwent conventional cemented total knee replacement without patella resurfacing using an anterior stabilized insert (CRAS) between 2018 and 2020 [ 9 ]. This study was approved by our local ethics committee.…”

“…From the available 126 THA candidates for evaluation, 105 (83.4%) were successfully reached and consented to be evaluated for study participation [ 7 ]. Similarly, of the 163 TKA candidates available, 131 (80.4%) were successfully contacted and consented to evaluation in the primary study [ 9 ]. Demographic data, including age at the time of surgery, gender, and follow-up durations, were recorded for both cohorts.…”

Increase in Postoperative Body Mass Index in Patients After Total Knee Arthroplasty

“…An observational study was designed with approval from the ethics committee and was conducted in accordance with the declaration of Helsinki. In a previous study [ 13 ], the hospital records were reviewed to identify patients who underwent TKA with a cruciate retaining (CR) model and anterior stabilized insert between 2018 and 2020. Patients with postoperative infection (n=1), instability (n=1) of the prosthesis, prostheses with a posterior stabilized insert, revisions, and unicompartmental arthroplasty were excluded.…”