Improved walking distance and range of motion predict patient satisfaction after TKA

Abstract

Purposes The focus in the evaluation of total knee arthroplasty has shifted from objective measures of implant position and knee function, to patient-reported outcome measures (PROMs). The relation between these two measures was investigated and the possibility of prediction of the patient satisfaction level was evaluated by defining thresholds for improvement of (1) range of motion (ROM), (2) 6-min walk test (6MWT), (3) sit-to-stand test (STS) and (4) quadriceps force after TKA? Methods Fifty-seven patients were prospectively tested at preoperative and 6 months postoperative intervals. The ROM, 6MWT, STS-test and quadriceps force were evaluated. Two clusters were created based on the postoperative KOOS, OKS and the satisfaction subscore of the new KSS, cluster 1 consisted of patients with good to excellent PROMs, cluster 2 of patients with poorer PROMs. Patients in each cluster were more similar to each other than to those in the other cluster. Receiver operating characteristic (ROC)-curve analysis was used to identify thresholds for the functional outcomes that established cluster allocation. Multiple logistic regression was used to define a model to predict cluster allocation. Results Patients with high postoperative PROMs (cluster 1 allocation) showed higher postoperative functional outcomes (p < 0.05). Thresholds for the improvement of ROM (≥ 5°, OR 6.3, 95% CI 1.23-31.84), 6MWT (≥ 50 m, OR 8.2, 95% CI 1.61-42.18) STS (≥ 1.05 s, OR 3, 95% CI 0.56-16.07) and normalized Q4 force (≥ 1.5 N/BMI, OR 2.5, 95% CI 0.49-12.89) were found to be predictors of cluster allocation. A model to predict the cluster allocation contained gender, ROM improvement and 6MWT improvement (sensitivity 91.1%, specificity 75%). Conclusions Thresholds for improvement of functional parameters can predict the patient satisfaction cluster. Patients, who are male, improve on the 6-min walk test with 50 m or more and have an increased range of motion of 5° or more, compared to the preoperative situation, are 6-8 times more likely of being satisfied after TKA. These tests are easy to use in clinical practice and can predict the level of patient satisfaction after TKA. Level of evidence Level II, prognostic study.

Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

“…Many participants expressed relief at the end of the interview when the researcher offered them an opportunity to receive more information and ask questions regarding their TKA. The therapeutic effect of qualitative interviews is also described in other patient groups [46][47][48].…”

Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study

“…The participants in our study described discontentment because they were not fully informed regarding the somewhat limited range of motion that could be expected postoperatively. A recent study showed that an improvement of five degrees in the range of motion in the knee after surgery along with an improved walking distance could increase the satisfaction rate by 6-8 times [49]. Other studies also agree with the effect of stiffness on satisfaction [50,51].…”

“…In the current study the patients' course of recovery was not investigated, only if there were complications or not. So it was not known whether these patients met the range of motion and walking distance improvements reported in the literature [49].…”

Rapid Skin Temperature Measurement is Valuable in Evaluating Inflammation and Functional Status After Total Knee Arthroplasty：A Case Control Study

“…and tissue cultures [3,9,16]. The methods used to evaluate functional recovery include an early postoperative range of motion (ROM) measurement, a quadriceps muscle strength measurement, the sit to stand test, the 6-minute walking test [18], and a psychological assessment [7].…”