Patient Satisfaction Following Primary Total Knee Arthroplasty: Contributing Factors

The reported dissatisfaction rate after primary total knee arthroplasty (TKA) ranges between 15% and 25%. The purpose of this article is to perform a narrative review of the literature with the aim of answering the following question: What are the main factors contributing to patient dissatisfaction after TKA? A review of the literature was performed on patient satisfaction after TKA. The search engines used were MedLine (PubMed) and the Cochrane Library. The keywords used were "TKA" and "satisfaction". The main reported preoperative factors positively contributing to patient satisfaction were the following: fulfilment of preoperative expectations, preoperative complete joint space collapse, increasing patellar and lateral compartment osteophyte size, and TKA communication checklist. The principal preoperative factors negatively contributing to patient satisfaction included female sex, comorbidities, and Hispanic race. The chief perioperative factor positively contributing to patient satisfaction was cosmetic closure, whereas the fundamental perioperative factors negatively contributing to patient satisfaction included joint laxity, anterior tibial component slope, and greater femoral component valgus angle. The principal postoperative factors positively contributing to patient satisfaction were the following: ameliorated walking distance, improved range of motion, and improvements in pain. The most important postoperative factors negatively contributing to patient satisfaction included poor postoperative knee stability and soft-tissue balance, functional limitation, surgical complication and reoperation, staff or quality of care issues, and increased stiffness.