Multifactorial analysis of dissatisfaction after primary total knee replacement

Area of Science:

• Orthopedic Surgery
• Psychological Medicine
• Patient Outcomes Research

Background:

• Assessing patient dissatisfaction after total knee replacement (TKR) is crucial for improving surgical outcomes.
• Understanding the psychological and physical factors contributing to dissatisfaction is key for patient-centered care.

Purpose of the Study:

• To determine the prevalence and reasons for dissatisfaction in private practice TKR patients.
• To compare psychological profiles of dissatisfied versus satisfied TKR patients.

Main Methods:

• A cohort of 301 unilateral TKR patients was assessed for dissatisfaction.
• Psychological assessments included the Pain Catastrophizing Scale (PCS), Depression, Anxiety and Stress Scale (DASS), and Multidimensional Health Locus of Control (MHLC).
• Matched controls were used for comparison, analyzing preoperative osteoarthritis grade, comorbidities, and postoperative functional outcomes (Oxford Knee Score - OKS, Range of Motion - ROM).

Main Results:

• Eight percent of patients were dissatisfied at a mean follow-up of 37 months, with persistent pain being the primary cause.
• Dissatisfied patients showed higher PCS and DASS depression scores, and lower internal locus of control.
• Reduced improvement in OKS and ROM, and lower preoperative osteoarthritis grade were observed in dissatisfied patients.

Conclusions:

• Dissatisfied TKR patients have distinct psychological profiles compared to satisfied patients.
• Both physical (e.g., ROM, OKS) and psychological factors (e.g., pain catastrophizing, depression) significantly contribute to TKR dissatisfaction.
• Identifying these factors enables the development of focused interventions to enhance patient satisfaction post-TKR.