Primary Total Knee Arthroplasty: Correlation between Preoperative Radiographic Severity of Arthritis and Postoperative Patient Satisfaction

Abstract

Predicting postoperative outcomes following total knee arthroplasty (TKA) is important for patient selection. This study focuses on patient-reported outcomes and satisfaction in relation to preoperative radiographic arthritis severity. A retrospective chart review of 420 TKAs was performed. Patient satisfaction was determined using a structured telephone survey with questions focused on degree of satisfaction whether they would have surgery again and their ability to kneel. The radiographic severity of the arthritis of the tibiofemoral joint was graded by a musculoskeletal radiologist using the Kellgren–Lawrence grading scale. The patellofemoral compartment was graded using the scale described by Jones et al. Those grouped as severe arthritis had an overall satisfaction rate of 96% (76% fully satisfied and 20% partially satisfied) compared with 82% of the time (64% fully satisfied and 18% partially satisfied) if their arthritis was mild. Postoperatively 51% of TKA patients were able to kneel. Univariate logistic regression showed an association between higher rates of satisfaction and male gender (p = 0.053), severity of preoperative radiographic arthritis (p = 0.034) those who would have surgery again (p ≤ 0.0001) and those able to kneel (p = 0.005). Patients should be informed preoperatively that if their arthritis is only mild radiographically, their outcomes are less predictable. There should also be a discussion surrounding kneeling and activities patients do, which may require kneeling, as many are unable to kneel postoperatively. The Level of Evidence for the study is III.

Key Factors for Achieving Expectations in Patient Satisfaction and Quality of Life After Knee Arthroplasty

“…Other methods included a simple binary scale (satisfied: yes or no), willingness to undergo surgery again (yes or no), and use of a numeric or visual analogue scale (VAS). Our internal review of more recent literature found similar single-question methods used in many studies [2][3][4][5][6][7][8][9][10][11][12].…”

“…A multitude of studies have investigated the ability of various factors to predict or correlate with patient satisfaction after TKA [3,9,10,[27][28][29][30][31][32][33][34][35]. Walker et al [12] found that the WOMAC score 1 year postoperatively could be used to predict patient satisfaction in 2578 patients.…”

“…Change in satisfaction from 6 to 12 months was predicted by improvements in WOMAC pain (OR, 1.24; P = 0.001), SF-12 PCS (OR, 1.55; P = 0.005), and SF-12 MCS (OR, 1.30; P = 0.01). Rooks et al [10] examined the relationship between preoperative radiographic severity of OA (Kellgren-Lawrence [K-L] scale) and patient satisfaction in 420 TKA patients 2-3 years postoperatively. Satisfaction was determined by selecting either very satisfied, no concerns with knee; partially satisfied, few concerns; or not satisfied.…”

“…The survey (0-100 points) was developed by two fellowship trained senior surgeons and included location and number of osteophytes, flexion contracture, patella thickness to soft tissue shadow, previous knee surgeries, obesity, diabetes, number and type of comorbidities, drug allergies, chronic opioid use before surgery, etiology of arthritis, and smoking (Table 12.6). Patient satisfaction was determined using a binary (yes or no) question and a continuous scale (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) in 484 patients in a mean of 1.5 years postoperatively. Patients with a higher survey score had greater odds of being satisfied (OR, 1.03; P = 0.003); BMI and age were not significant predictors of satisfaction.…”

How Much Improvement Can Satisfy Patients? Exploring Patients’ Satisfaction 3 Years After Total Knee Arthroplasty

“…Based on this nding, preoperative joint width rather than exion contracture of knee seems to be appropriate to represent the severity of arthritis. In the study conducted by Katie Rooks, they found out that the severity of preoperative radiographic arthritis(K-L grading scale)was associated with a higher degree of satisfaction [20] . This conclusion was in accordance with our result as well.…”