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Patient dissatisfaction following total knee replacement: a growing concern?
D Nam1, R M Nunley1, R L Barrack1
1Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, 660 S. Euclid Ave., Campus Box 8233, St. Louis, Missouri, USA.
The Bone & Joint Journal
|November 9, 2014
Summary
Most total knee replacement (TKR) patients report satisfaction, but many experience residual symptoms. Recent surgical techniques and implant designs have not improved patient-perceived outcomes for TKR.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Patient outcomes research
Background:
- Total knee replacement (TKR) is a common procedure to alleviate pain and improve function in patients with knee osteoarthritis.
- Despite high overall satisfaction rates, a significant proportion of patients report residual symptoms and dissatisfaction after TKR.
- Contemporary implant designs and surgical techniques aim to enhance patient-perceived outcomes.
Purpose of the Study:
- To assess patient satisfaction and residual symptoms following total knee replacement (TKR).
- To evaluate the impact of modern implant designs and surgical techniques on patient-perceived outcomes.
- To identify factors associated with dissatisfaction after TKR.
Main Methods:
- A national, multi-center study utilizing a blinded, third-party survey center.
- Administration of a questionnaire to quantify patient satisfaction and residual symptoms post-TKR.
- Analysis of outcomes based on implant designs (gender-specific, high-flex, rotating platform) and surgical techniques (custom cutting guides - CCG, kinematic alignment vs. mechanical alignment).
Main Results:
- 90% of patients reported overall satisfaction with knee function, but only 66% felt their knee was 'normal'.
- Residual symptoms and functional problems were reported by 33% to 54% of patients.
- Female patients and those from low-income households had higher odds of dissatisfaction.
- Contemporary implant designs and CCG with a neutral mechanical axis did not improve perceived outcomes.
- Kinematic alignment TKR showed a trend towards more patients reporting a 'normal' feeling knee compared to mechanical alignment TKR.
Conclusions:
- A notable percentage of patients experience dissatisfaction and residual symptoms after TKR.
- Current advancements in implant design and surgical techniques have not demonstrably improved patient-perceived outcomes.
- Further research into optimizing TKR techniques, potentially including kinematic alignment, is warranted to improve patient satisfaction and reduce residual symptoms.
