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Improved walking distance and range of motion predict patient satisfaction after TKA

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purposes

The focus in the evaluation of total knee arthroplasty has shifted from objective measures of implant position and knee function, to patient-reported outcome measures (PROMs). The relation between these two measures was investigated and the possibility of prediction of the patient satisfaction level was evaluated by defining thresholds for improvement of (1) range of motion (ROM), (2) 6-min walk test (6MWT), (3) sit-to-stand test (STS) and (4) quadriceps force after TKA?

Methods

Fifty-seven patients were prospectively tested at preoperative and 6 months postoperative intervals. The ROM, 6MWT, STS-test and quadriceps force were evaluated. Two clusters were created based on the postoperative KOOS, OKS and the satisfaction subscore of the new KSS, cluster 1 consisted of patients with good to excellent PROMs, cluster 2 of patients with poorer PROMs. Patients in each cluster were more similar to each other than to those in the other cluster. Receiver operating characteristic (ROC)-curve analysis was used to identify thresholds for the functional outcomes that established cluster allocation. Multiple logistic regression was used to define a model to predict cluster allocation.

Results

Patients with high postoperative PROMs (cluster 1 allocation) showed higher postoperative functional outcomes (p < 0.05). Thresholds for the improvement of ROM (≥ 5°, OR 6.3, 95% CI 1.23–31.84), 6MWT (≥ 50 m, OR 8.2, 95% CI 1.61–42.18) STS (≥ 1.05 s, OR 3, 95% CI 0.56–16.07) and normalized Q4 force (≥ 1.5 N/BMI, OR 2.5, 95% CI 0.49–12.89) were found to be predictors of cluster allocation. A model to predict the cluster allocation contained gender, ROM improvement and 6MWT improvement (sensitivity 91.1%, specificity 75%).

Conclusions

Thresholds for improvement of functional parameters can predict the patient satisfaction cluster. Patients, who are male, improve on the 6-min walk test with 50 m or more and have an increased range of motion of 5° or more, compared to the preoperative situation, are 6–8 times more likely of being satisfied after TKA. These tests are easy to use in clinical practice and can predict the level of patient satisfaction after TKA.

Level of evidence

Level II, prognostic study.

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References

  1. Rolfson O, Bohm E, Franklin P, Lyman S, Denissen G, Dawson J, Dunn J, Eresian Chenok K, Dunbar M, Overgaard S, Garellick G, Lübbeke A (2016) Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 87(Suppl 1):9–23

    Article  Google Scholar 

  2. Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW (1996) Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplast 11:831–840

    Article  CAS  Google Scholar 

  3. Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA knee. Clin Orthop Relat Res 471:127–133

    Article  Google Scholar 

  4. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN (2003) Knee range of motion after total knee arthroplasty: How important is this as an outcome measure? J Arthroplast 18:286–294

    Article  Google Scholar 

  5. Vissers MM, de Groot IB, Reijman M, Bussmann JB, Stam HJ, Verhaar J (2010) Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty. BMC Musculoskelet Disord 11:121

    Article  Google Scholar 

  6. Bullens PHJ, van Loon CJM, de Waal Malefijt MC, Laan RFJM., Veth RPH (2001) Patient satisfaction after total knee arthroplasty. J Arthroplast 16:740–747

    Article  CAS  Google Scholar 

  7. Insall J, Tria AJ, Scott WN (1973) The total condylar knee prosthesis: the first 5 years. Clin Orthop Relat Res 145:68–77

    Google Scholar 

  8. Insall JN, Kelly M (1986) The total condylar prosthesis. Clin Orthop Relat Res 205:43–48

    Google Scholar 

  9. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  10. Vince KG, Insall JN, Kelly MA (1989) The total condylar prosthesis. 10- to 12-year results of a cemented knee replacement. J Bone Joint Surg Br 71:793–797

    Article  CAS  Google Scholar 

  11. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  Google Scholar 

  12. Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25(11):3354–3359

    Article  Google Scholar 

  13. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  Google Scholar 

  14. Van Onsem S, Van Der Straeten C, Arnout N, Deprez P, Van Damme G, Victor J (2016) A new prediction model for patient satisfaction after total knee arthroplasty. J Arthroplast 31:2660–2667

    Article  Google Scholar 

  15. Scott CEH, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258

    Article  CAS  Google Scholar 

  16. Stone OD, Duckworth AD, Curran DP, Ballantyne JA, Brenkel IJ (2017) Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(8):2573–2579

    Article  CAS  Google Scholar 

  17. Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T (2010) Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter? Physiother Res Int 15:126–134

    Article  Google Scholar 

  18. Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH (1987) Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing. Phys Ther 67:1342–1347

    Article  CAS  Google Scholar 

  19. Dowsey M, Choong FM (2013) The utility of outcome measures in total knee replacement surgery. Int J Rheumatol 2013:506–518

    Article  Google Scholar 

  20. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Jt Surg Am 86–A:963–974

    Article  Google Scholar 

  21. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    Article  CAS  Google Scholar 

  22. Haverkamp D, Breugem SJM, Sierevelt IN, Blankevoort L, van Dijk CN (2005) Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty. Acta Orthop 76:347–352

    Article  Google Scholar 

  23. Ko V, Naylor JM, Harris IA, Crosbie J, Yeo AET (2013) The six-minute walk test is an excellent predictor of functional ambulation after total knee arthroplasty. BMC Musculoskelet Disord 14:145

    Article  Google Scholar 

  24. Mooi E, Sarstedt M (2011) A concise guide to market research: the process, data and methods using IBM SPSS statistics. Int J Mark Res 53:563–564

    Article  Google Scholar 

  25. Alnahdi AH, Zeni JA, Snyder-Mackler L (2016) Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty. Knee Surgery Sport Traumatol Arthrosc 24:2587–2594

    Article  Google Scholar 

  26. Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG (2010) Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 468:2460–2468

    Article  Google Scholar 

  27. Cattell RB (1943) The description of personality. I. Foundations of trait measurement. Psychol Rev 50:559–594

    Article  Google Scholar 

  28. Haldar P, Pavord ID, Shaw DE, Berry MA, Thomas M, Brightling CE, Wardlaw AJ, Green RH (2008) Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 178:218–224

    Article  Google Scholar 

  29. Reutter A (2003) TwoStep cluster analysis. IBM Software, Bus Anal SPSS, pp 1–5

  30. Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum 51:100–109

    Article  Google Scholar 

  31. Nashi N, Hong CC, Krishna L (2014) Residual knee pain and functional outcome following total knee arthroplasty in osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 23(6):1841–1847

    Article  Google Scholar 

  32. Tungtrongjit Y, Weingkum P, Saunkool P (2012) The effect of preoperative quadriceps exercise on functional outcome after total knee arthroplasty. J Med Assoc Thai 95(Suppl 1):S58–S66

    PubMed  Google Scholar 

  33. Naylor JM, Mills K, Buhagiar M, Fortunato R, Wright R (2016) Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods. BMC Musculoskelet Disord 17:390

    Article  CAS  Google Scholar 

  34. Bohannon RW (2006) Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot Skills 103:215–222

    Article  Google Scholar 

  35. Mizner RL, Billing S (2005) Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 35(7):424–436

    Article  Google Scholar 

  36. Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L (2008) Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech 23:320–328

    Article  Google Scholar 

  37. Farquhar SJ, Reisman DS, Snyder-Mackler L (2008) Persistence of altered movement patterns during a sit-to-stand task 1 year following unilateral total knee arthroplasty. Phys Ther 88:567–579

    Article  Google Scholar 

  38. Jones CA, Voaklander DC, Suarez-Alma ME (2003) Determinants of function after total knee arthroplasty. Phys Ther 83:696–706

    PubMed  Google Scholar 

  39. Dowsey MM, Spelman T, Choong PFM (2016) Development of a prognostic nomogram for predicting the probability of nonresponse to total knee arthroplasty 1 year after surgery. J Arthroplasty 31(8):1654–1660

    Article  Google Scholar 

  40. Van Der Straeten C, Witvrouw E, Willems T, Bellemans J, Victor J (2013) Translation and validation of the Dutch New Knee Society Scoring System©. Clin Orthop Relat Res 471:3565–3571

    Article  Google Scholar 

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Acknowledgements

The authors wish to acknowledge Prof. T. Willems and the Department of Rehabilitation Sciences and Physiotherapy, Ghent University for the technical support and providing the handheld dynamometer.

Funding

The article was funded by FWO (Grant no. 12N5117N) and BOF (Grant no. 01AN00513).

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Stefaan Van Onsem, Matthias Verstraete, Sebastiaan Dhont, Bert Zwaenepoel & Jan Victor

  2. MSk Lab, Imperial College London, Floor 7, Laboratory Block, Charing Cross Campus, London, UK

    Catherine Van Der Straeten

Authors
  1. Stefaan Van Onsem
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  2. Matthias Verstraete
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  3. Sebastiaan Dhont
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  4. Bert Zwaenepoel
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  5. Catherine Van Der Straeten
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  6. Jan Victor
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Corresponding author

Correspondence to Stefaan Van Onsem.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical Approval was obtained with the Belgian Registration-number B670201419601.

Informed Consent

All patients completed an informed consent before the testing was performed.

Additional information

Investigation performed at Ghent University Hospital, Belgium.

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Van Onsem, S., Verstraete, M., Dhont, S. et al. Improved walking distance and range of motion predict patient satisfaction after TKA. Knee Surg Sports Traumatol Arthrosc 26, 3272–3279 (2018). https://doi.org/10.1007/s00167-018-4856-z

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  • DOI: https://doi.org/10.1007/s00167-018-4856-z

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