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Patient response to osteotomy around the knee joint at one year post-operation—fulfilment of expectations and current health status

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

The aim of this study was to investigate patient satisfaction and fulfilment of expectations after osteotomy around the knee at one year postoperatively, using patient-related outcome measures.

Materials and methods

From the initial sample of 264 patients, a total of 132 patients (age 48y ± 11) were enrolled in this prospective study (response rate 49.3%). Data were collected using the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES), items for satisfaction and the Knee injury and Osteoarthritis Outcome Score (KOOS) measures. At one year postoperative follow-up, an individualized questionnaire asked whether the specific person-related expectations had been fulfilled.

Results

Satisfaction was high with 83.2% of all participants at one year after surgery. A total of 78% of patients stated they would decide to do the surgery again. This decision was significantly associated with satisfaction, younger age and better KOOS scores scales before surgery for pain, activity and sports. We found high correlations between satisfaction and fulfilment of expectations for the HFES-KSES. Fulfilment of expectations one year after surgery was significantly associated with significant improvements in KOOS scales at one year post-operation. Expectations (1) “to get the knee back to normal status”, (2) “improve ability to squat”, (3) “improve ability to run”, (4) “improve ability to kneel” had been fulfilled worst. A multiple linear regression model for satisfaction had an R2 = 0.797 of the variance. The most influential was the variable fulfilment of “maintain health” that had 70.7% of variance.

Conclusions

The fulfilled expectation concerning an improvement of the ability to maintain health was the most influential parameter for satisfaction at one year post-osteotomy. Patients with better health status of the knee and younger age rated the surgery to be more positive and were also more likely to do the surgery again. This provides an indication for an earlier intervention, before the knee and overall health status becomes more detrimental.

Level of evidence: Level II (Therapeutic study).

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References

  1. Holschen M, Lobenhoffer P (2015) Complications of corrective osteotomies around the knee. Orthopade 45(1):13–23. https://doi.org/10.1007/s00132-015-3199-4

    Article  Google Scholar 

  2. Kohn L et al (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):146–151. https://doi.org/10.1007/s00167-012-2016-4

    Article  CAS  PubMed  Google Scholar 

  3. Schenke M et al (2017) Corrective osteotomies of the lower limb show a low intra- and perioperative complication rate-an analysis of 1003 patients. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4566-y

    Article  PubMed  Google Scholar 

  4. Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24(2):61–69. https://doi.org/10.5792/ksrr.2012.24.2.61

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schroter S et al (2013) Return to work and clinical outcome after open wedge HTO. Knee Surg Sports Traumatol Arthrosc 21(1):213–219. https://doi.org/10.1007/s00167-012-2129-9

    Article  PubMed  Google Scholar 

  6. Minzlaff P et al (2013) Osteochondral autologous transfer combined with valgus high tibial osteotomy: long-term results and survivorship analysis. Am J Sports Med 41(10):2325–2332. https://doi.org/10.1177/0363546513496624

    Article  PubMed  Google Scholar 

  7. Ihle C et al (2016) Health-related quality of life and clinical outcomes following medial open wedge high tibial osteotomy: a prospective study. BMC Musculoskelet Disord 17(1):215–226. https://doi.org/10.1186/s12891-016-1076-x

    Article  PubMed  PubMed Central  Google Scholar 

  8. Saier T et al (2017) Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):934–942. https://doi.org/10.1007/s00167-015-3938-4

    Article  PubMed  Google Scholar 

  9. Ferner F et al (2022) Perioperative complications in osteotomies around the knee: a study in 858 cases. Arch Orthop Trauma Surg 142(5):769–775. https://doi.org/10.1007/s00402-020-03696-w

    Article  PubMed  Google Scholar 

  10. Haanstra TM et al (2012) Systematic review: do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health Qual Life Outcomes 10:152. https://doi.org/10.1186/1477-7525-10-152

    Article  PubMed  PubMed Central  Google Scholar 

  11. Scott CE et al (2012) Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 94(7):974–981. https://doi.org/10.1302/0301-620X.94B7.28219

    Article  CAS  PubMed  Google Scholar 

  12. Suda AJ et al (2010) Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics 33(2):76–80. https://doi.org/10.3928/01477447-20100104-07

    Article  PubMed  Google Scholar 

  13. Mancuso CA et al (2009) Fulfillment of patients’ expectations for total hip arthroplasty. J Bone Joint Surg Am 91(9):2073–2078. https://doi.org/10.2106/JBJS.H.01802

    Article  PubMed  Google Scholar 

  14. Noble PC et al (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43. https://doi.org/10.1097/01.blo.0000238825.63648.1e

    Article  PubMed  Google Scholar 

  15. Gandhi R, Davey JR, Mahomed N (2009) Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty 24(5):716–721. https://doi.org/10.1016/j.arth.2008.05.016

    Article  PubMed  Google Scholar 

  16. Engel C et al (2004) Impact of two types of expectancy on recovery from total knee replacement surgery (TKR) in adults with osteoarthritis. Behav Med 30(3):113–123. https://doi.org/10.3200/BMED.30.3.113-123

    Article  PubMed  Google Scholar 

  17. Deakin AH et al (2019) Fulfilment of preoperative expectations and postoperative patient satisfaction after total knee replacement. A prospective analysis of 200 patients. Knee 26(6):1403–1412. https://doi.org/10.1016/j.knee.2019.07.018

    Article  PubMed  Google Scholar 

  18. Grunwald L et al (2019) Patients’ expectations of osteotomies around the knee are high regarding activities of daily living. Knee Surg Sports Traumatol Arthrosc 27(9):3022–3031. https://doi.org/10.1007/s00167-018-5326-3

    Article  PubMed  Google Scholar 

  19. Kim MS et al (2020) Patient expectations and satisfaction after medial opening wedge high tibial osteotomy. J Arthroplasty 35(12):3467–3473. https://doi.org/10.1016/j.arth.2020.06.076

    Article  PubMed  Google Scholar 

  20. Gstottner M et al (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128(1):111–115. https://doi.org/10.1007/s00402-007-0438-0

    Article  PubMed  Google Scholar 

  21. Benzakour T et al (2010) High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. Int Orthop 34(2):209–215. https://doi.org/10.1007/s00264-009-0937-4

    Article  PubMed  PubMed Central  Google Scholar 

  22. Takahara Y et al (2021) Mid-term results of medial open-wedge high tibial osteotomy based on radiological grading of osteoarthritis. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04011-x

    Article  PubMed  Google Scholar 

  23. Mancuso CA et al (2001) Patients’ expectations of knee surgery. J Bone Joint Surg Am 83A(7):1005–1012

    Article  Google Scholar 

  24. Roos EM et al (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96. https://doi.org/10.2519/jospt.1998.28.2.88

    Article  CAS  PubMed  Google Scholar 

  25. Bund DR (2013) Sozialmedizinisches Glossar der Deutschen Rentenversicherung. DRV Schriften, Berlin

    Google Scholar 

  26. Lin BJ et al (2021) Predictors of met expectations two years after knee surgery. J Orthop 25:10–15. https://doi.org/10.1016/j.jor.2021.03.022

    Article  PubMed  PubMed Central  Google Scholar 

  27. Williamson T et al (2016) Use of the knee injury and osteoarthritis outcome score in a healthy United States population. Am J Sports Med 44(2):440–446. https://doi.org/10.1177/0363546515616812

    Article  PubMed  Google Scholar 

  28. Daltroy LH et al (1998) Preoperative education for total hip and knee replacement patients. Arthritis Rheum 11(6):469–478

    Article  CAS  Google Scholar 

  29. Johansson K et al (2005) Preoperative education for orthopaedic patients: systematic review. J Adv Nurs 50(2):212–223. https://doi.org/10.1111/j.1365-2648.2005.03381.x

    Article  PubMed  Google Scholar 

  30. Kruzik N (2009) Benefits of preoperative education for adult elective surgery patients. AORN J 90(3):381–387. https://doi.org/10.1016/j.aorn.2009.06.022

    Article  PubMed  Google Scholar 

  31. Kiyak HA, Vitaliano PP, Crinean J (1988) Patients’ expectations as predictors of orthognathic surgery outcomes. Health Psychol 7(3):251–268. https://doi.org/10.1037//0278-6133.7.3.251

    Article  CAS  PubMed  Google Scholar 

  32. Bumberger A et al (2022) Specific knowledge and resilience affect short-term outcome in patients following primary total hip arthroplasty. Arch Orthop Trauma Surg 142(6):1229–1237. https://doi.org/10.1007/s00402-021-03967-0

    Article  PubMed  Google Scholar 

  33. Kumar M, Battepathi P, Bangalore P (2015) Expectation fulfilment and satisfaction in total knee arthroplasty patients using the “PROFEX” questionnaire. Orthop Traumatol Surg Res 101(3):325–330. https://doi.org/10.1016/j.otsr.2014.12.016

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are not compensated, and there are no other institutional subsidies, corporate affiliations or funding sources supporting this work unless clearly documented and disclosed. This study was performed with the assistance of German Knee Society (DKG). Last but not least, we would like to thank Moritz Herbst for his extraordinary work coordinating all the follow up consultations.

Funding

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Author information

Authors and Affiliations

  1. Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Tübingen, Germany

    Leonard Grünwald

  2. Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany

    Steffen Schröter

  3. Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany

    Jörg Dickschas

  4. Department of Orthopedics and Traumatology, Helmut-G.-Walther Klinikum, Prof.-Arneth-Straße 2B, 96215, Lichtenfels, Germany

    Jörg Harrer

  5. Orthoclinic Agatharied, Krankenhaus Agatharied GmbH, Norbert-Kerkel-Platz, 83734, Hausham, Germany

    Philipp Minzlaff

  6. OrthoPlus München, Alte Börse, Lenbachplatz 2a, 80333, Munich, Germany

    Stefan Hinterwimmer

  7. Berufsgenossenschaftliche Unfallklinik Murnau, Prof-Küntscher-Str. 8, 82418, Murnau, Germany

    Tim Saier

  8. Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Girish Pattappa & Peter Angele

  9. Sporthopaedicum Regensburg, Hildegard-Von Bingen-Str. 1, 93053, Regensburg, Germany

    Peter Angele

  10. Klinik für Trauma und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany

    Peter Angele

  11. Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany

    Philipp Minzlaff

  12. Klinik für Unfallchirugie und Orthopädische Chirurgie, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlange, Maximilianspl. 2, 91054, Erlangen, Germany

    Jörg Dickschas

  13. Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany

    Leonard Grünwald, Steffen Schröter, Jörg Harrer & Peter Angele

Authors
  1. Leonard Grünwald
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Contributions

LG created the database, data acquisition, statistics and drafting the manuscript. SS was involved in study design, data acquisition and final editing. JD was involved in study design, data acquisition, literature research and final editing. JH was involved in study design, data acquisition, literature research and final editing. PM was involved in data acquisition and final editing. SH was involved in data acquisition and final editing. TS was involved in study design and data acquisition. GP was involved in result discussion and drafting the manuscript. PA was involved in study design, data acquisition, literature research and final editing.

Corresponding author

Correspondence to Leonard Grünwald.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval about all aspects of the study from an ethical and legal point of view was obtained (Bavarian State Medical Chamber, IRB number: 14104).

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Written informed consent was obtained from all patients prior to evaluation.

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Grünwald, L., Schröter, S., Dickschas, J. et al. Patient response to osteotomy around the knee joint at one year post-operation—fulfilment of expectations and current health status. Arch Orthop Trauma Surg 143, 3965–3973 (2023). https://doi.org/10.1007/s00402-022-04660-6

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