A New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty

Onsem, Stefaan Van; Straeten, Catherine Van Der; Arnout, Nele; Deprez, Patrick; Damme, Geert Van; Victor, Jan

doi:10.1016/j.arth.2016.06.004

Cited by 117 publications

(86 citation statements)

References 34 publications

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“…Several studies have indicated that not all but only 68~93% of the patients undergoing TKA are satisfied. In this study, we obtained a patient satisfaction rate of 83.8% at postoperative 1 year after TKA, which is comparable to the rates reported previously [3,[6][7][8].…”

Section: Discussionsupporting

confidence: 89%

“…Patient's satisfaction is now being considered as an important aspect in the evaluation of a TKA outcome [5]. Despite the rapid advancement in the surgical technology, facilities, and prosthesis, studies indicate that patient's satisfaction with TKA is only 68 to 93% [3,[6][7][8]. Edwards et al reported that at least one fourth of the patients experienced substantial pain and functional limitation 1 year after TKA, whereas without any clear physical or functional reasons [9].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

et al. 2020

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Background: Despite the continued improvement in the surgical techniques during primary total knee arthroplasty (TKA), literatures indicate that up to 10 to 20% patients are not satisfied with their outcomes. Psychological factors in this dissatisfaction are yet to be clearly identified. The aim of this study is to develop a method to assess whether the patient's current mental state is suitable enough to accept a TKA surgery. Methods: Preoperative demographic and clinical data of 532 patients who underwent TKA were prospectively obtained from January 2012 until December 2016. We recorded the scores evaluated by SF-36 questionnaire and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperatively and 1 year postoperatively. Preoperative Life Satisfaction Rating (LSR) is emphatically evaluated. Results: Poor preoperative score of LSR was a significant predictor of dissatisfaction after TKA. Patients with low LSR reported significant pain and stiffness, although there was no remarkable effect on functionality of the replaced joint. The results also showed that age and BMI were not strong predictors of satisfaction in TKA. Conclusion: Our outcomes can help clinicians evaluate whether a patient's current mental status is favorable for TKA. If patients have extreme low scores of LSR (less than 10), a psychological intervention should be recommended for better satisfaction following a TKA surgery. This would also allow surgeons to individually assess the risks and benefits of surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

et al. 2020

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“…Risk calculators, appropriateness tools and predictive models have been developed to predict clinical outcomes and revision surgery, but these instruments lack the ability to provide precise thresholds that reliably predict failure and have not been validated using external datasets . Early efforts using large administrative datasets in the United States to develop a predictive tool of 30‐day readmission rates have had some success .…”

Section: Patient Characteristics Influencing Decision Makingmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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“…This is created by performing bony cuts perpendicular to the long axis of the femur and tibia and adding soft tissue release of the surrounding ligaments to balance the knee where required [1]. This mechanical alignment (MA) technique has been considered well performed when the overall limb alignment is within three degrees of neutral, however at least 10-12% of patients remain dissatisfied with the resulting outcome using this technique [2,3], with older papers reporting higher rates of dissatisfaction at about 20% [4][5][6].…”

Section: Introduction/purposementioning

confidence: 99%

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Twiggs²,

Leie

et al. 2019

The Knee

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Background: Kinematically aligned (KA) total knee arthroplasty (TKA) has emerged as an alternative approach to the intraoperative alignment targets of mechanically aligned (MA) TKA. While the clinical outcomes of the two philosophies have been investigated, further investigation is required to quantify exactly how the two philosophies differ in their approach to correcting the deformities encountered in osteoarthritic knees such as fixed flexion deformities (FFD) and coronal malalignment. The aim of this paper was to compare MA and KA philosophies in TKA in terms of the intra-operative correction of FFD and coronal malalignment and quantify the way in which each philosophy achieves a well-balanced knee that can reach full extension. Methods: A retrospective review of prospective data collected from 210 consecutive TKAs performed by a single surgeon between March 2015 and May 2017 was undertaken. MA and KA cases were compared in terms of pre-operative patient deformity and characteristics, intraoperative steps taken to correct FFD (including bony resections, soft tissue releases and components used) and postoperative alignment achieved. Results: One hundred twenty MA and 90 KA TKAs were analysed. There was no significant difference in terms of patient age, gender and preoperative coronal and sagittal deformity between the two cohorts. KA TKAs were able to achieve the same degree of sagittal correction as MA TKAs with less total bony resection (16.7 mm vs. 18.9 mm, p b 0.0001), less soft tissue releases (10% vs. 49.2%, p b 0.0001). This was achieved with a difference in component alignment. The femur was in more valgus (−2.5 vs. −0.03°, p b 0.0001), the tibia in more varus (2.3 vs. 0.3°, p b 0.0001), and the overall alignment slightly more varus in the KA group (1.1 vs. 0.4°, p = 0.007), without significant difference in the proportion of patients within three degrees of a neutral axis. Conclusion: This study shows that using a kinematic alignment philosophy in total knee arthroplasty results in the achievement of extension range-of-motion and soft tissue balance goals with less bone resection and less soft tissue release. This allows for bone stock preservation and minimization of trauma due to soft tissue release. Further study is required to correlate these results with patient reported outcomes and determine their clinical significance. Level of evidence: IIIretrospective cohort study.

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A New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty

Cited by 117 publications

References 34 publications

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study

Selecting and optimising patients for total knee arthroplasty

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

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