Background A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction. Questions/purposes We asked whether (1) psychological factors, as measured by preoperative self-reported questionnaires, predicted poor outcome after TKA, and (2) whether certain psychological factors examined predicted poor outcome better than others. Methods We performed a systematic review and metaanalysis of prospective observational studies published in MEDLINE, CINAHL 1 , EMBASE TM , and PsycINFO 1 databases from their date of inception to October 2013, augmented with a manual search of bibliographies. Study eligibility was performed according to an a priori protocol. Included studies were assessed for quality according to the Newcastle-Ottawa scale. Two reviewers independently performed the search, identified eligible studies, assessed their methodologic quality, and extracted data. Outcomes of interest included postoperative dissatisfaction, pain, or limited function of the patients.

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Purpose A proportion of TKA recipients following TKA are dissatisfied with their outcome. Our hypothesis is that patient satisfaction with TKA and perception of success of surgery are associated with patient comorbidities and overall health status, surgical and anaesthetic techniques as well as processes of post-operative care after TKA. The aims were to (i) measure the incidence of patient unfavourable outcomes-defined as dissatisfaction with the surgery or lack of joint-specific global improvement-1 year after TKA, and to explore the differences between these two outcomes of interest; (ii) assess the relationship between the development of these unfavourable outcomes and patient-reported knee function and overall quality of life; (iii) explore the associations between pre-and peri-operative variables and the development of these unfavourable outcomes 1 year after TKA. Methods This study includes analysis of data from a prospective cohort of 1017 TKA recipients. Pre-operative patient variables, surgical and acute-care data were collected. The Oxford knee score and the global perception of improvement were used to assess satisfaction and success 365 days post-surgery. Results From 1017 patients (56% female), mean age 68 years and BMI 32, 68 pts (7%) were dissatisfied with the outcome of surgery, 141 pts (14%) believed surgery was unsuccessful 1 year after TKA. A negative outcome was noted in 151 (15%) patients for either satisfaction or success, and 58 (6%) of patients reported neither good satisfaction nor success after surgery. Dissatisfied patients reported worse mean OKS (26.4 [SD 8.03] vs 42.3 [SD 5.21], p < 0.001) and mean EQ VAS (64.9 [SD 19.49] vs 81.8 [SD 14.38], p < 0.001) than satisfied patients. Patients who reported unsuccessful surgery also showed significantly lower mean OKS (30.9 [SD 9.29] vs 42.9 [SD 4.39], p < 0.001) and mean EQ VAS (68.2 [SD 18.61] vs 82.7 [SD 13.77], p < 0.001). Univariate analysis of predictors of unfavourable outcome post-TKA showed that financial status, obstructive sleep apnoea (OSA), ASA class > 2 and not resurfacing the patella were factors associated with the development of dissatisfaction with TKA and with patient perceived unsuccessful results of TKA. Multivariable logistic regression of patient satisfaction and success of TKA showed that compensation cases (OR 26.91, p < 0.001 for dissatisfaction and OR 11.49, p = 0.001 for unsuccessful TKA), obstructive sleep apnoea (OR 2.18, p = 0.04 for dissatisfaction and OR 1.82, p = 0.04 for unsuccessful TKA), ASA grade > 2 (OR 1.83, p = 0.04 for dissatisfaction and OR 1.57, p = 0.03 for unsuccessful TKA) and the development of a complication after TKA (OR 3.4, p < 0.001 for dissatisfaction and OR 2.39, p < 0.001 for unsuccessful TKA) were associated with the development of a negative outcome in both groups. Patella preservation (OR 1.96, p = 0.03) was associated with dissatisfaction, whereas the use of cruciate retaining femoral prosthesis was associated with less successful results of TKA (OR 1.78, p = 0.009). Conclusions An ...

We present a single case of fracture of an Exeter femoral prosthesis at the neck, occurring after a fall from standing height, in a lean 70yr lady at 6 years post implantation. The fracture propagated from the insertion dimple on the superior aspect of the prosthesis shoulder. Materials analysis suggested variance in composition of the alloy, particularly with grain size heterogeneity. Whilst Exeter femoral prosthesis fracture is extremely rare, when it does occur the literature suggests it is often in the context of excessive mechanical stresses (obesity, high offset, falls). However, this case may represent a failure of materials rather than mechanical stresses alone.

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Introduction The purpose of this study was to assess if severity of radiographic changes of knee arthritis was associated with patient improvement after total knee arthroplasty (TKA). We hypothesised that patients with mild arthritis were more likely to report lower satisfaction, improvement in knee function and Oxford knee score (OKS) compared to patients with moderate or severe arthritis. Materials and methods Secondary analysis of prospectively collected data from TKA patients of two arthroplasty centres with knee radiographs available for assessment of disease severity. Patients completed the Oxford knee score (OKS) and were asked to rate the global improvement in knee condition and their satisfaction at 6 months post-TKA. Bivariable analysis and multivariable regression models were used to test the association between disease severity and each outcome. Results 2226 patients underwent primary TKA and 3.6% had mild arthritis. Mean OKS improved from 17.0 (SD 18.0) to 38.0 (SD 8.1) 6 months after TKA. Two hundred and twenty-two patients (10%) reported ‘Poor’ or ‘Fair’ satisfaction, and 173 (8%) reported knee function was ‘Much worse’, ‘A little worse’ or ‘About the same’ 6 months post-TKA. Patients with mild arthritis showed improvement in OKS [mean improvement in OKS = 19 (SD 15)], but were significantly more likely to report dissatisfaction (OR = 3.10, 95% CI 1.62 to 5.91, p = 0.006), lack of improvement (OR = 4.49, 95% CI 2.38 to 8.47, p < 0.001) and lower OKS scores (− 3 points, 95% CI − 5.39 to − 0.85, p = 0.008) compared to patients with moderate to severe arthritis. Conclusions While patients with mild radiographic arthritic changes improve after TKA, they were significantly more likely to report higher rates of dissatisfaction, less improvement in knee function and OKS compared to patients with moderate-severe grades of arthritis.

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