Why are patients dissatisfied following a total knee replacement? A systematic review

Nakano, Nobuaki; Shoman, Haitham; Olavarría, Fernando; Matsumoto, Tomoyuki; Kuroda, Ryosuke; Khanduja, Vikas

doi:10.1007/s00264-020-04607-9

Cited by 73 publications

(52 citation statements)

References 36 publications

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“…Haynes et al reported that younger patients still do achieve a clinically significant improvement after TKA, even though they tend to have less severe radiographic OA and more severe clinical symptoms than older patients before surgery [ 18 ]. Unlike Scott et al or Nakano et al, we found that BMI had no association with dissatisfaction [ 9 , 30 ]. Therefore, although obesity is a well-known risk factor for knee OA and the risk for both prosthetic joint infection and revision surgery is markedly increased among obese patients, based on this study they seem to be as satisfied with the outcome of TKA as non-obese patients[ 21 , 36 ].…”

Section: Discussioncontrasting

confidence: 90%

“…This finding is supported by Scott et al, who reported that over 50 % of patients with KL 2 OA are dissatisfied after TKA [ 9 ]. A systematic review by Nakano et al assessing dissatisfaction after TKA in patients of all ages had a similar finding as well [ 30 ]. Also Niemeläinen et al found mild radiographic OA to be related to dissatisfaction [ 11 ].…”

Section: Discussionmentioning

confidence: 61%

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Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up

Leppänen

Niemeläinen

Eskelinen

2021

BMC Musculoskelet Disord

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Background and aims The incidence of total knee arthroplasty (TKA) is increasing, especially among younger working-age patients. However, dissatisfaction rates in this population are higher than among older patients. The aim of this study was to assess the rates of dissatisfaction and persistent pain after TKA and to evaluate those factors that predict these outcomes. Material and methods In total, 186 patients undergoing unilateral TKA aged 65 years or less were enrolled into this prospective observational study with 2-year follow-up. To assess the outcome, the visual analogue scales regarding satisfaction and persistent pain at rest and during exercise were used. In addition, the association between patients´ demographics, radiographic severity of knee osteoarthritis (OA), patient-reported outcome measures (PROMs) and dissatisfaction and persistent pain were tested by univariate logistic regression analysis. Mild OA was defined as Kellgren-Lawrence (KL) grade 2 and severe OA as KL grade 3–4. Furthermore, multiple logistic regression analysis was also conducted to test statistically significant relations. Results After 2 years, 12 % (n = 23) of patients were dissatisfied with the outcome of TKA, 27 % (n = 50) reported persistent pain during exercise and 10 % (n = 18) at rest. Patients with mild knee OA were significantly more dissatisfied (28.6 %) than patients with more severe OA (8.7 %) (p = 0.003). Younger patients had an increased risk for both dissatisfaction and persistent pain. Apart from KOOS Quality of Life, poor preoperative KOOS subscores were also predictive for these outcomes. Conclusion Mild radiographic knee OA was the main predicting factor for dissatisfaction after TKA. Thus, performing TKA for such patients should be carefully considered. Furthermore, these patients should be informed about the increased risk for dissatisfaction and the same seems to apply to younger patients. Interestingly, when TKA is performed for patients with more severe knee OA, the satisfaction rates seem to be somewhat higher than those previously reported. Trial registration The study was retrospectively registered with ClinicalTrials.gov (registration number NCT03233620) on 28 July 2017.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 61%

Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up

Leppänen

Niemeläinen

Eskelinen

2021

BMC Musculoskelet Disord

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“…Knee replacement surgery has been shown to improve quality of life for KOA sufferers and is cost effective [ 9 ]. However, not all may benefit from it as unfortunately up to 20% of those undergoing TKA are dissatisfied with the outcome [ 23 , 24 ] due to continued pain, with a further 2–3% experiencing life-altering complications. In our patient cohort, a very low number of adverse events were recorded.…”

Section: Discussionmentioning

confidence: 99%

Microfragmented Adipose Tissue Injection (MFAT) May Be a Solution to the Rationing of Total Knee Replacement: A Prospective, Gender-Bias Mitigated, Reproducible Analysis at Two Years

Heidari

Borg²,

Olgiati

et al. 2021

Stem Cells International

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Background. Knee osteoarthritis (KOA) is a significant cause of disability in a globally ageing population. Knee replacement surgery has been shown to improve function and quality of life. Access to this intervention can be limited for a number of reasons including rationing of care, lack of healthcare provision in austere environments, and more recently, due to the cessation of elective orthopaedic care as a result of the COVID pandemic. Referral for knee replacement surgery is often guided by the patient’s Oxford Knee Score (OKS). Recent therapies including treatment with microfragmented adipose tissue (MFAT) have emerged as alternatives to relieve pain and improve function in such patients. Method. We identified all patients with KOA Kellgren-Lawrence grade 3 and 4 in our dataset of patients treated with a single injection of MFAT and applied published OKS thresholds for referral for TKR to separate them into 3 cohorts according to their functional impairment. 220 patients (95 females, 125 males) with KOA were given one MFAT injection. The function (OKS) and quality of life (EuroQol-5) prior to and 24 months after therapy were compared. Results. MFAT injection provided a statistically significant improvement in the quality of life (EQ-5D) at 24 months in patients with a baseline OKS of 39 or less ( p value: <0.001) as well as those with OKS of 27 or less who are deemed suitable for a knee replacement ( p value: <0.001). Conclusion. MFAT injection improves quality of life in patients with KOA who are deemed suitable for the knee replacement. MFAT is a low-morbidity alternative biological treatment and can delay the need for total knee replacement in suitable patients.

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“…The goal of performing a TKA is to achieve a painless and stable knee joint with a functional range of motion (ROM) [ 2 ]. Patient satisfaction following TKA is influenced by a multitude of factors of which post-operative improvement in range of movement and meeting pre-operative patient expectation are key to achieving successful outcomes [ 3 ]. The 10-year implant survival rate is reported to be 96.1%, and the 20-year implant survival rate is 89.7% [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Management of Stiffness following Total Knee Arthroplasty: International Survey on Surgeon Preferences

Kumar

Mamarelis

Pettit

et al. 2021

SICOT-J

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Introduction: Stiffness following total knee arthroplasty (TKA) is a challenging complication and can result in a poor functional outcome. There is considerable debate concerning the definition, work-up, and optimal management of this complication. The aim of this study was to record the definition of stiffness, management practices, and expectations of outcome among surgeons from an international community using a peer-reviewed questionnaire. Methods: A 23-item peer-reviewed online questionnaire was sent to all members of SICOT to gauge and record the management practices and expectations of outcome in the management of patients with stiffness following TKA. Results: A total of 315 surgeons completed this peer-reviewed questionnaire. Manipulation under anaesthesia (MUA) was the preferred treatment option for stiffness post-TKA, with a majority of the surgeons opting to carry out this procedure between 6 and 12 weeks following the index TKA. Physiotherapy and a continuous passive motion device were also used by the majority of surgeons following MUA, as additional treatment measures. Discussion: MUA is perceived to be a safe and effective primary treatment option for stiffness following TKA. It is best performed between weeks 6 and 12 with expected gains in range of motion from 10 to 20 degrees in 75% of patients.

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Why are patients dissatisfied following a total knee replacement? A systematic review

Cited by 73 publications

References 36 publications

Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up

Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up

Microfragmented Adipose Tissue Injection (MFAT) May Be a Solution to the Rationing of Total Knee Replacement: A Prospective, Gender-Bias Mitigated, Reproducible Analysis at Two Years

Management of Stiffness following Total Knee Arthroplasty: International Survey on Surgeon Preferences

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