Predicting dissatisfaction following total knee replacement

Abstract

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month SF-12 score and poorer improvement in the pain element of the Oxford Knee Score. Patient expectations were highly correlated with satisfaction. Satisfaction following TKR is multifactorial. Managing the expectations and mental health of the patients may reduce dissatisfaction. However, the most significant predictor of dissatisfaction is a painful total knee replacement.

Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

“…Dissatisfaction ranged from 7.5% to 28.3% (median, 18.6%). Psychological health was deemed a significant predictor in satisfaction at a minimum followup of 6 months after TKA in four studies [18,24,27,44]; another study attributed patient dissatisfaction to postoperative stiffness, but did not comment on the effect of mental health state of patients [28].…”

“…There was 89% agreement in the quality rating between the two investigators. Only two studies justified their sample size and provided a power analysis [39,44]. All studies had a minimum 6-month followup period.…”

“…The studies were conducted in seven countries: 10 in the USA [3,5,8,9,13,14,24,34,39,46]; four in the UK [27,34,44,50]; four in Canada; [18,26,34,47]; and one each in Australia [34], Spain [15], Greece [37], and Korea [28]. Most studies (17) were conducted in metropolitan populations; one study was a multinational cohort study conducted in 13 centers in four countries (UK, USA, Australia, and Canada) [34].…”

“…There was considerable heterogeneity in the self-reported psychological questionnaires used to measure [3,14,15,18,24,26,28,34,44]. Two other studies [8,9] used the State Trait Anxiety Index and the Beck Depression Index.…”

“…Fifteen studies used the WOMAC to measure patientreported pain and function outcomes after surgery [3, 9, 13-15, 18, 24, 26, 28, 34, 37, 39, 46, 47, 50]. The Oxford Knee Score was used in three other studies [5,27,44] and the Knee Society Score was used in two studies [8,9]. Patient satisfaction was assessed directly in only five studies [18,24,27,28,44], measured using a four-point Likert scale in three [18,28,44] and a three-point scale in another study [24].…”