Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature

Gunaratne, Rajitha; Pratt, Dylan N.; Banda, Joseph; Fick, Daniel; Khan, Riaz J.K.; Robertson, Brett W.

doi:10.1016/j.arth.2017.07.021

Cited by 558 publications

(403 citation statements)

References 30 publications

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“…Both internal and external factors have been recognized as determinants of patient's satisfaction [12,26]. In case of TKA, the external factors associated with patient's satisfaction include anesthesia, postoperative pain management, surgical technique, implant type, and postoperative rehabilitation [27]. Considering that the surgical procedure, operating surgeon, and the rehabilitation guidance were the same for all patients, we assumed that it was the multiple internal factors that affect the patients' satisfaction instead of external factors in the cohort.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study found that some independent factors, such as work status, living alone, social support, and comorbidities, have considerable impact on TKA outcomes [30]. In fact, apart from the degree of disability, retirement status and socioeconomic status were found to influence the scores of LSR [27,31]. A recent study showed that waiting time longer than 6 months negatively influenced post-operative satisfaction and patientrelated outcome because of a lower level of functional reserves and mental health [32].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

et al. 2020

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Background: Despite the continued improvement in the surgical techniques during primary total knee arthroplasty (TKA), literatures indicate that up to 10 to 20% patients are not satisfied with their outcomes. Psychological factors in this dissatisfaction are yet to be clearly identified. The aim of this study is to develop a method to assess whether the patient's current mental state is suitable enough to accept a TKA surgery. Methods: Preoperative demographic and clinical data of 532 patients who underwent TKA were prospectively obtained from January 2012 until December 2016. We recorded the scores evaluated by SF-36 questionnaire and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperatively and 1 year postoperatively. Preoperative Life Satisfaction Rating (LSR) is emphatically evaluated. Results: Poor preoperative score of LSR was a significant predictor of dissatisfaction after TKA. Patients with low LSR reported significant pain and stiffness, although there was no remarkable effect on functionality of the replaced joint. The results also showed that age and BMI were not strong predictors of satisfaction in TKA. Conclusion: Our outcomes can help clinicians evaluate whether a patient's current mental status is favorable for TKA. If patients have extreme low scores of LSR (less than 10), a psychological intervention should be recommended for better satisfaction following a TKA surgery. This would also allow surgeons to individually assess the risks and benefits of surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

et al. 2020

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“…Despite large benefits associated with TKA, suboptimal outcomes do occur. Up to 24% of patients experience a serious adverse event, and about 20% experience ongoing pain and dissatisfaction . In light of these statistics, paramount to the decision to undergo TKA is the determination of whether it is appropriate at an individual patient level.…”

Section: Who Should Undergo Tka For Osteoarthritis?mentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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“…Previous studies have found that some patients with residual symptoms report high satisfaction with their outcomes 22,23 reflecting that satisfaction is a different or boarder concept than pain relief. The key factors reported to be associated with satisfaction include degree of improvement in pain and function, and patient expectations 20,21 . Other important factors include depression and pain in other body parts 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Satisfaction is a multidimensional construct, stretching beyond pain relief and functional improvement to encompass many different factors related to a person's psychological status, experience and expectations 19 . However, patient satisfaction after KR is a less well studied concept compared to pain relief and functional improvement 20,21 . Symptomatic relief and satisfaction may not be equivalent 22,23 .…”

Section: Introductionmentioning

confidence: 99%

Pre-operative pressure pain thresholds do not meaningfully explain satisfaction or improvement in pain after knee replacement: a cohort study

Leung

Lim

Fan

et al. 2019

Osteoarthritis and Cartilage

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Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature

Cited by 558 publications

References 30 publications

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

Selecting and optimising patients for total knee arthroplasty

Pre-operative pressure pain thresholds do not meaningfully explain satisfaction or improvement in pain after knee replacement: a cohort study

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