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Multifactorial analysis of dissatisfaction after primary total knee replacement.

Kunal Dhurve1, Corey Scholes1, Sherif El-Tawil1

  • 1Sydney Orthopaedic Research Institute, L1, 445 Victoria Avenue, Chatswood, NSW 2067, Australia.

The Knee
|May 29, 2017
PubMed
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Dissatisfaction after knee replacement is linked to psychological factors like pain catastrophizing and depression, alongside poorer functional outcomes. Identifying these elements can guide targeted interventions for better patient satisfaction.

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).
Keywords:
Patient-reported outcomesPsychosocialSatisfactionTKR

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  • 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.