Postoperative alignment and ROM affect patient satisfaction after TKA

Abstract

Background: Patient satisfaction has increasingly been recognized as an important measure after total knee arthroplasty (TKA). However, we do not know yet how and why the patients are satisfied or dissatisfied with TKA.

Questions/purposes: We asked: (1) After TKA, how satisfied are patients and which activities were they able to do? (2) Are patient-derived scores related to physician-derived scores? (3) Which factors affect patient satisfaction and function?

Methods: We retrospectively evaluated 375 patients who had undergone 500 TKAs between February 22, 2000 and December 1, 2009. We sent a questionnaire for The 2011 Knee Society Knee Scoring System to the patients. We determined the correlation of patient- and physician-derived scores and factors relating to the five questions relating to satisfaction and the 19 questions relating function. The minimum followup was 2 years (mean, 5 years; range, 2-11 years).

Results: The mean score for symptoms was 19 (74%), 23 (59%) for patient satisfaction, 10 (64%) for patient expectations, and 53 (53%) for functional activities. We found a poor correlation between the patient-derived and the physician-derived scores. Old age and varus postoperative alignment negatively correlated with the satisfaction. Varus alignment and limited range of motion (ROM) negatively correlated with the expectation. Old age, rheumatoid arthritis, and limited ROM negatively correlated with the functional activities.

Conclusions: Most patients did not report symptoms, but they experienced difficulty with activities of daily living after TKA. Patient satisfaction is difficult to measure, but avoiding varus alignment and achieving better ROM appear to be important for increasing satisfaction and meeting expectations.

Fig. 1

The graph shows the relationship between the patient-derived symptom score of the 2011 Knee Society score and the physician-derived Knee Society pain score. Linear regression analysis showed a poor correlation between the patient-derived symptom scores and the physician-derived pain scores.

Fig. 2

The graph shows the relationship between the patient-derived functional activities score of the 2011 Knee Society score and the physician-based Knee Society functional score. Linear regression analysis showed a weak correlation between the patient-derived total functional score and the physician-derived functional score.