Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Clement, Nicholas D.; Bardgett, Michelle; Weir, David J.; Holland, J; Deehan, David J.

doi:10.1007/s00167-018-4979-2

Cited by 31 publications

(33 citation statements)

References 31 publications

(42 reference statements)

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“…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].…”

Section: Discussionmentioning

confidence: 69%

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

Mahdi

Svantesson

Wretenberg

et al. 2020

Preprint

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Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are discontented without known explanation. Contentment and discontentment have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the discontentment rate. Methods Of the 348 patients who responded to a letter asking if they were contented or discontented with their surgery, 61 (18%) reported discontentment. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment one year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and need for buttresses. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a need for buttresses, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after surgery.

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Section: Discussionmentioning

confidence: 69%

“…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].…”

Section: Discussionmentioning

confidence: 92%

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

Mahdi

Svantesson

Wretenberg

et al. 2020

Preprint

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“…One potential advantage of the WOMAC score is the separation of the component scores, evaluating pain, function and stiffness The Journal of Knee Surgery separately, which is not possible with the OKS. The components of the preoperative WOMAC score that include pain, 7,8 function, 8,11 and stiffness 11,25 have all been shown to be independent predictors of satisfaction after TKA. Despite this the threshold values identified in the current study for the preoperative WOMAC scores were poor predictors of dissatisfaction, being at best only 63% specific and sensitive to identify such patients.…”

Section: Discussionmentioning

confidence: 99%

Is there a Threshold Preoperative WOMAC Score That Predicts Patient Satisfaction after Total Knee Arthroplasty?

et al. 2019

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The aim of this study was to identify threshold preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores that were predictive of patient dissatisfaction 1 year after total knee arthroplasty (TKA). A retrospective cohort of 3,324 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, comorbidities, and the WOMAC score were collected preoperatively. Patient satisfaction was assessed at 1 year using four questions that focused on: overall outcome, activity, work, and pain. Receiver operating characteristic (ROC) curve analysis was used to identify threshold values predictive of dissatisfaction. The overall satisfaction rate at 1 year was 89.7% (n = 2982). Patients who were satisfied had a significantly greater preoperative pain (3.6, 95% confidence interval [CI] 1.6–5.6, p < 0.001) and functional (4.5, 95% CI 2.6–6.5, p < 0.001) component and total (4.2, 95% CI 2.3–6.0, p < 0.001) WOMAC scores compared with those who were dissatisfied. ROC curve analysis demonstrated the preoperative pain (p = 0.001) and functional (p < 0.001) components and total (p < 0.001) WOMAC scores were significant predictors of satisfaction. Patients scoring < 36 for the pain and function components and < 35 for the total WOMAC score were more likely to be dissatisfied with their overall outcome, but the area under the curves (AUCs) for these predictive threshold values were 0.56, 0.54, and 0.60, respectively, indicating poor prognostic value. A similar finding was observed for satisfaction with pain relief and ability to work and recreational activities; however, in addition the stiffness component was also a significant (p < 0.001) predictor with a threshold value of < 43. Again, these thresholds were of poor prognostic value with an AUC of less than 0.57 for all these satisfaction questions. Threshold values in the preoperative component and total WOMAC scores were not reliable prognostic indicators of overall patient satisfaction or for satisfaction with pain relief, ability to do work, or recreational activities after TKA.

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“…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.…”

Section: Discussionmentioning

confidence: 50%

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

Mahdi

Svantesson

Wretenberg

et al. 2020

BMC Musculoskelet Disord

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Background: Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients' experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate. Methods: Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients' experiences of discontentment 1 year after total knee arthroplasty. Results: The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion: Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

show abstract

Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Cited by 31 publications

References 31 publications

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

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

Is there a Threshold Preoperative WOMAC Score That Predicts Patient Satisfaction after Total Knee Arthroplasty?

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

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