High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty

Abstract

Background TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients. Questions/purposes We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA.

New Total Knee Arthroplasty Designs: Do Young Patients Notice?

“…Although TKA continues to be effective in providing pain relief and improved function in the majority of patients with degenerative joint disease [26,28,44], recent studies have demonstrated a high percentage of patients undergoing TKA to experience residual symptoms and dissatisfaction [9,[33][34][35]. Furthermore, because the volume of TKAs is disproportionately increasing in younger patients, function and satisfaction in this group of patients becomes even more important [23,43].…”

“…If a second refusal occurred, no further attempts were made. The final data were sent from the UWSC through a secure web site in SPSS format (Version 16.0; SPSS Inc, Chicago, IL, USA) [34].…”

“…The principle questions related to residual symptoms inquired about the presence of any pain or stiffness in the knee; audible noises from the knee including popping, clicking, or grinding; and experiencing any swelling or a sense of tightness in the knee. To assess function, the patient was asked about the ability to get in and out of a car, getting in and out of a chair, going up and down stairs, and the presence of any limp [5,34].…”

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

“…According to gait analyses and biomechanical studies, patients require at least 83°of flexion to ascend stairs, 90°to 100°to descend stairs, 93°to 105°to rise from a standard or short chair, and more than 115°to squat or kneel [3,11,13]. However, up to 20% of patients may develop knee stiffness and achieve knee flexion of less than 90°after their index arthroplasty [12,17,19,28]. If left untreated, knee stiffness reduces the functional outcomes of patients including their daily living activities and satisfaction [25,26].…”

Modern Total Knee Arthroplasty Designs: Are we Improving Outcomes?

“…Although the results of classic TKA designs have been previously reported as excellent with a 93% survival rate at 15 years [3], recent studies focusing on patient satisfaction as the primary outcome measure have been less encouraging, with the Ontario Joint Registry showing that only 70% of patients met their expectations one year after TKA [4]. This "un-satisfaction" rate is also higher in younger individuals requiring early intervention because of severe knee osteoarthritis: Parvizi et al [5] reported only 66% of young patients (< 60 years) indicating their knees feeling normal at 1 to 4 years after primary TKA. Because of these reports, in recent years, several manufacturers have implemented specific design modifications in the attempt to improve patient outcomes: between those modifications, highflexion femoral components and increased modularity (femoral, tibial, polyethylene thickness and patellar sizes) have captured particular attentions by many designers.…”