Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

Abstract

Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are discontented without known explanation. Contentment and discontentment have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the discontentment rate. Methods Of the 348 patients who responded to a letter asking if they were contented or discontented with their surgery, 61 (18%) reported discontentment. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment one year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and need for buttresses. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a need for buttresses, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after surgery.

Development of a Personalized m/eHealth Algorithm for the Resumption of Activities of Daily Life Including Work and Sport after Total and Unicompartmental Knee Arthroplasty: A Multidisciplinary Delphi Study

“…Internationally, several studies investigated guidelines and (exercise) recommendations for postacute, postoperative physical therapy after UKA or TKA, but none of these studies provided (evidence on the) recovery recommendations for activities of daily life [ 32 , 33 , 34 , 35 ]. These findings are in line with the studies from Nouri et al [ 14 ] and Mahdi et al [ 13 ], who both showed that patients expressed the need for mutual guidelines and advice regarding return to daily activities. Given the finding that preoperative expectations are one of the main determinants to influence postoperative patient satisfaction, realistic and multidisciplinary recovery recommendations regarding resumption of daily life activities could improve patient satisfaction after surgery [ 19 , 23 , 36 , 37 ].…”

“…Despite the good clinical outcomes with significant pain relief and improved knee function in most patients who receive knee arthroplasty, approximately 20% of the patients are dissatisfied postoperatively [ 12 ]. In a recent study, Mahdi et al concluded that 6–30% of knee arthroplasty patients had unfulfilled expectations regarding their ability to resume daily activities after surgery [ 13 ]. From a study with interviews among 45 knee arthroplasty patients, it was concluded that patients received little guidance and support regarding the resumption of daily activities [ 14 ].…”

Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery

“…Another possible explanation of increased anxiety may be due in part to the patients' awareness of the prosthesis. A prior qualitative study reported that some participants worry because their prosthesis feels foreign to their bodies and they fear that it could initiate an inflammatory response, induce a malignancy, or lead to more surgery (46).…”

Weight control in older adults with knee osteoarthritis: a qualitative study

“…However, surgeries for total joint replacement have long waiting lists in the UK [ 15 ], which means that these patients need to bear with their painful joint symptoms and live with lower QOL until the surgery. Moreover, evidence indicates that receiving joint-replacement surgery may not relieve all symptoms for some OA patients [ 16 , 17 ], and 18% of patients are discontented with the outcome [ 18 ]. These contradictory evidence-based results may make it difficult for patients with knee OA to decide what treatment to choose.…”