, Volume 472, Issue 1, pp 133-137
Date: 24 Sep 2013

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

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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.

Methods

In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19–60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies.

Results

Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days.

Conclusions

When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients’ expectations to a level that is likely to be met by the procedure as it now is performed.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

The institution of one or more of the authors has received, during the study period, funding from 3 M (St Paul, MN, USA) (JP), Baxter Healthcare Corp (Deerfield, IL, USA) (JP), Biomet Inc (Warsaw, IN, USA) (RLB, AVL, KRB, WGH, RMN), DePuy Orthopaedics, Inc, a Johnson and Johnson company (Warsaw, IN, USA) (JP, WGH), EOS Imaging Inc (Cambridge, MA, USA) (RLB, RMN), Inova Health Care Services (Falls Church, VA, USA) (WGH), Medical Compression Systems, Inc (West Hills, CA, USA) (RLB, RMN), Musculoskeletal Transplant Foundation (Edison, NJ, USA) (JP), NIH (Bethesda, MD, USA) (RLB, JP), Smith & Nephew, Inc (Memphis, TN, USA) (RLB, JP, CDV, RMN), Stryker Orthopaedics (Mahwah, NJ, USA) (RLB, AVL, JP, CDV, RMN), Wright Medical Technology, Inc (Arlington, TN, USA) (RLB, RMN), and Zimmer Inc (Warsaw, IN, USA) (JP). The institutions of the authors have received funding from Stryker Orthopaedics in support of this study.
One of the authors certifies that he (JP) has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of USD 10,000 to 100,000 from 3 M, an amount of USD 10,000 to 100,000 from Cadence Pharmaceuticals, Inc (San Diego, CA, USA), an amount of USD 10,000 to 100,000 from CeramTec (Laurens, SC, USA), an amount of USD 10,000 to 100,000 from Pfizer (New York, NY, USA), an amount of USD 10,000 to 100,000 from Salient Surgical (Minneapolis, MN, USA), an amount of USD 10,000 to 100,000 from TissueGene (Rockville, MD, USA), and an amount of USD 10,000 to 100,000 from Zimmer Inc.
One of the authors certifies that he (RMN) has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Smith & Nephew, Inc, an amount of less than USD 10,000 from Wright Medical Technology, Inc, an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of less than USD 10,000 from CardioMEMS (Atlanta, GA, USA), and an amount of less than USD 10,000 from Integra LifeSciences (Plainsboro, NJ, USA).
One of the authors certifies that he (KRB) has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000, from Biomet, Inc.
One of the authors certifies that he (AVL) has received or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc, and an amount of USD 10,000 to 100,000 from Innomed, Inc (Savannah, GA, USA).
One of the authors certifies that he (WGH) has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to 1,000,000 from DePuy, a Johnson and Johnson company, and an amount of USD 10,000 to 100,000 from Medtronic.
One of the authors certifies that he (CJD) has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet, Inc, an amount of USD 10,000 to USD 100,000 from CD Diagnostics (Wynnewood, PA, USA), an amount of less than USD 10,000 from ConvaTec (Skillman, NJ, USA), an amount of USD 10,000 to USD 100,000 from Smith & Nephew, Inc, and an amount of USD 10,000 to USD 100,000 from Stryker Orthopaedics.
One of the authors certifies that he (RLB) has received or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Smith & Nephew, Inc, and an amount of more than USD 1,000,001 from Stryker Orthopaedics.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Washington University School of Medicine (St Louis, MO, USA), Joint Implant Surgeons, Inc (New Albany, OH, USA), Rothman Institute of Orthopedics at Thomas Jefferson University (Philadelphia, PA, USA), Midwest Orthopaedics at Rush (Chicago, IL, USA), and Anderson Orthopaedic Clinic (Arlington, VA, USA).