Less improvement in knee function and higher rates of dissatisfaction in the short-term following total knee arthroplasty in people with mild radiographic arthritis

Abstract

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.

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

“…Lateral facetectomy also can decrease the rate of lateral release and reduce the rate of damage of the lateral geniculate artery (15)(16)(17) . We thought that lateral facetectomy can decrease AKP over constraining the PFJ is incompatible with freedom of motion in recent prosthesis.…”

“…Total 12(80%) out of 15 Patients were satisfied with TKA results of Group A. Total 14 (93%) out of 15 Patients were satisfied with TKA results in group B .Patellar replacement involves the removal of the patient's natural patella and replacement with an artificial one (15) . The artificial patella is designed to match the patient's anatomy and provide a smooth surface for the joint to glide on.…”

What can we expect from patellar denervation in knee arthroplasty? An updated systematic review and meta-analysis

“…This may also be explained by the fact that knee strength or knee function is influenced by many factors other than pain. 42–45…”

“…This may also be explained by the fact that knee strength or knee function is influenced by many factors other than pain. [42][43][44][45] Despite claimed to be safer than patellar resurfacing, there are probable adverse events that may be caused by denervation. Gupta et al 46 suggested that there might be a probability of proprioceptive disturbance after PD that could lead to load bearing derangement.…”