Why are patients dissatisfied following a total knee replacement? A systematic review

Abstract

Background: Although total knee replacement (TKR) is an effective intervention for end-stage arthritis of the knee, a significant number of patients remain dissatisfied following this procedure. Our aim was to identify and assess the factors affecting patient satisfaction following a TKR.

Materials and methods: In accordance with the PRISMA guidelines, two reviewers searched the online databases for literature describing factors affecting patient satisfaction following a TKR. The research question and eligibility criteria were established a priori. Any clinical outcome study that described factors relating to overall satisfaction after primary TKR was included. Quality assessment for the included studies was performed by two accredited orthopaedic surgeons experienced in clinical research.

Results: The systematic review identified 181 relevant articles in total. A history of mental health problems was the most frequently reported factor affecting patient satisfaction (13 reportings). When the results of the quality assessment were taken into consideration, a negative history of mental health problems, use of a mobile-bearing insert, patellar resurfacing, severe pre-operative radiological degenerative change, negative history of low back pain, no/less post-operative pain, good post-operative physical function and pre-operative expectations being met were considered to be important factors leading to better patient satisfaction following a TKR.

Conclusion: Surgeons performing a TKR should take these factors into consideration prior to deciding whether a patient is suitable for a TKR. Secondarily, a detailed explanation of these factors should form part of the process of informed consent to achieve better patient satisfaction following TKR. There is a great need for a unified approach to assessing satisfaction following a TKR and also the time at which satisfaction is assessed.

Keywords: Dissatisfaction; Satisfaction; Systematic review; Total knee arthroplasty; Total knee replacement.

Fig. 1

PRISMA flowchart for results of the literature database search

Fig. 2

Number of reportings in seven groups of factors for patient satisfaction following total knee replacement. Blue bar means FACTOR (‘it is a factor for patients’ satisfaction’) and orange bar means Not-FACTOR (‘it is a factor which does NOT relate to patients’ satisfaction’)

Fig. 3

Sum of percentage from full score (%) based on the quality assessment in each type of study for each factor. Blue bar means FACTOR (‘it is a factor for patients’ satisfaction’) and orange bar means Not-FACTOR (‘it is a factor which does NOT relate to patients’ satisfaction’). a Patients’ demographical factors. b Patients’ non-knee factors. c Patients’ knee factors. d Factors of implants/prostheses. e Intra-operative technical factors. f Post-operative outcome factors. g Surgeon and healthcare factors

Fig. 3

Sum of percentage from full score (%) based on the quality assessment in each type of study for each factor. Blue bar means FACTOR (‘it is a factor for patients’ satisfaction’) and orange bar means Not-FACTOR (‘it is a factor which does NOT relate to patients’ satisfaction’). a Patients’ demographical factors. b Patients’ non-knee factors. c Patients’ knee factors. d Factors of implants/prostheses. e Intra-operative technical factors. f Post-operative outcome factors. g Surgeon and healthcare factors

Fig. 3

Sum of percentage from full score (%) based on the quality assessment in each type of study for each factor. Blue bar means FACTOR (‘it is a factor for patients’ satisfaction’) and orange bar means Not-FACTOR (‘it is a factor which does NOT relate to patients’ satisfaction’). a Patients’ demographical factors. b Patients’ non-knee factors. c Patients’ knee factors. d Factors of implants/prostheses. e Intra-operative technical factors. f Post-operative outcome factors. g Surgeon and healthcare factors