What makes patients aware of their artificial knee joint?

Abstract

BackgroundJoint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). Findings from qualitative and psychometric studies suggest that joint awareness is a distinct concept especially relevant to patients with good surgical outcome and patients at late follow-up time points. The aim of this study was to improve the understanding of the concept of joint awareness by identifying situations in which patients are aware of their artificial knee joint and to investigate what bodily sensations and psychological factors raise a patient’s awareness of her/his knee. In addition, we evaluated the relative importance of patient-reported outcome parameters that are commonly assessed in orthopaedics.MethodsQualitative interviews were conducted with patients being at least 12 months after TKA. The interviews focused on when, where and for what reasons patients were aware of their artificial knee joint. To evaluate the relative importance of ‘joint awareness’ after TKA among nine commonly assessed outcome parameters (e.g. pain or stiffness), we collected importance ratings (‘0’ indicating no importance at all and ‘10’ indicating high importance).ResultsWe conducted interviews with 40 TKA patients (mean age 69.0 years; 65.0% female). Joint awareness was found to be frequently triggered by kneeling on the floor (30%), climbing stairs (25%), and starting up after resting (25%). Patients reported joint awareness to be related to activities of daily living (68%), specific movements (60%), or meteoropathy (18%). Sensations causing joint awareness included pain (45%) or stiffness (15%). Psychological factors raising a patient’s awareness of his/her knee comprised for example feelings of insecurity (15%), and fears related to revision surgeries, inflammations or recurring pain (8%). Patients’ importance ratings of outcome parameters were generally high and did not allow differentiating clearly among them.ConclusionsWe have identified a wide range of situations, activities, movements and psychological factors contributing to patients’ awareness of their artificial knee joints. This improves the understanding of the concept of joint awareness and of a patient’s perception of his/her artificial knee joint. The diversity of sensations and factors raising patient’s awareness of their joint encourages taking a broader perspective on outcome after TKA.

Body‐Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework

“…In one, 42% of THR and 80% of TKR recipients attested to perceiving the joint as “artificial” (rather than “native or natural”) on a simple questionnaire designed to assess joint perception . Some recipients experience conscious awareness of the joint when it functions differently during certain tasks . They report vigilance and protective urges toward their knees, hesitating to exercise or risk falling .…”

“…You're thinking about this new thing you have inside your body” . Anything that draws one's attention to the new joint can also produce joint awareness, affecting patient experiences . The “squeaking hip,” for example, is a phenomenon of audible squeaking after THR with use of ceramic‐on‐ceramic bearings .…”

“…To adopt a framing from the transplant literature, one desired outcome may be implicit embodiment—using the implant like the native body part. Like a prosthetic limb, an artificial knee will seldom function exactly like the original one (having a more limited range of motion or being uncomfortable to kneel on, for example) . Unlike a prosthetic limb, a knee has little to no effect on the body's shape, size, or boundaries in the world (peripersonal space), a major focus of recent research on prosthetics .…”

The Forgotten Joint Score-12 in Swedish patients undergoing knee arthroplasty: a validation study with the Knee Injury and Osteoarthritis Outcome Score (KOOS) as comparator

“…The conceptual generality of joint awareness may be a disadvantage with the FJS-12. Although the versatility is likely to provide a sensitive measurement of both improvement and deterioration, as well as differences that can occur between patients, it may also allow for psychological factors to influ-ence the scores, such as insecurity and fear of complications (Loth et al 2018).…”

3D Puzzle in Cube Pattern for Anisotropic/Isotropic Mechanical Control of Structure Fabricated by Metal Additive Manufacturing

“…Furthermore, the useful life of artificial joints is considered to be 15-20 years, although there are individual differences depending on the patient's age and level of activity [12]. A long period of use implies the increased potential for complications, including inconsistency between the shapes of the artificial joint and the living bone, loosening due to the difference in the mechanical functions, and surgical site infection.…”