Skip to main content
SpringerLink
Log in

Postoperative Alignment and ROM Affect Patient Satisfaction After TKA

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patient satisfaction has increasingly been recognized as an important measure after total knee arthroplasty (TKA). However, we do not know yet how and why the patients are satisfied or dissatisfied with TKA.

Questions/purposes

We asked: (1) After TKA, how satisfied are patients and which activities were they able to do? (2) Are patient-derived scores related to physician-derived scores? (3) Which factors affect patient satisfaction and function?

Methods

We retrospectively evaluated 375 patients who had undergone 500 TKAs between February 22, 2000 and December 1, 2009. We sent a questionnaire for The 2011 Knee Society Knee Scoring System to the patients. We determined the correlation of patient- and physician-derived scores and factors relating to the five questions relating to satisfaction and the 19 questions relating function. The minimum followup was 2 years (mean, 5 years; range, 2–11 years).

Results

The mean score for symptoms was 19 (74%), 23 (59%) for patient satisfaction, 10 (64%) for patient expectations, and 53 (53%) for functional activities. We found a poor correlation between the patient-derived and the physician-derived scores. Old age and varus postoperative alignment negatively correlated with the satisfaction. Varus alignment and limited range of motion (ROM) negatively correlated with the expectation. Old age, rheumatoid arthritis, and limited ROM negatively correlated with the functional activities.

Conclusions

Most patients did not report symptoms, but they experienced difficulty with activities of daily living after TKA. Patient satisfaction is difficult to measure, but avoiding varus alignment and achieving better ROM appear to be important for increasing satisfaction and meeting expectations.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Baumann C, Rat AC, Mainard D, Cuny C, Guillemin F. Importance of patient satisfaction with care in predicting osteoarthritis-specific health-related quality of life one year after total joint arthroplasty. Qual Life Res. 2011;20:1581–1588.

    Article  PubMed  Google Scholar 

  2. Becker R, Doring C, Denecke A, Brosz M. Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:1433–1441.

    Article  PubMed  Google Scholar 

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    PubMed  CAS  Google Scholar 

  4. Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K. Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res. 2010;468:542–546.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty. 2001;16:740–747.

    Google Scholar 

  7. Callaghan JJ, O’Rourke M R, Saleh KJ. Why knees fail: lessons learned. J Arthroplasty. 2004;19:31–34.

    Article  PubMed  Google Scholar 

  8. Cohen SB, Strand V, Aguilar D, Ofman JJ. Patient- versus physician-reported outcomes in rheumatoid arthritis patients treated with recombinant interleukin-1 receptor antagonist (anakinra) therapy. Rheumatology (Oxford). 2004;43:704–711.

    Article  CAS  Google Scholar 

  9. Culliton SE, Bryant DM, Overend TJ, Macdonald SJ, Chesworth BM. The relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty. 2012;27:490–492.

    Article  PubMed  Google Scholar 

  10. Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ. Patient-reported activity level after total knee arthroplasty. J Arthroplasty. 2008;23:401–407.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  12. Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS. Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty. 2011;26:178–186.

    Article  PubMed  Google Scholar 

  13. Fitzgerald SJ, Trousdale RT. Why knees fail in 2011: patient, surgeon, or device? Orthopedics. 2011;34:e513–e515.

    PubMed  Google Scholar 

  14. Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty. 2009;24:716–721.

    Article  PubMed  Google Scholar 

  15. Gandhi R, de Beer J, Petruccelli D, Winemaker M. Does patient perception of alignment affect total knee arthroplasty outcome? Can J Surg. 2007;50:181–186.

    PubMed  Google Scholar 

  16. Ghanem E, Pawasarat I, Lindsay A, May L, Azzam K, Joshi A, Parvizi J. Limitations of the Knee Society Score in evaluating outcomes following revision total knee arthroplasty. J Bone Joint Surg Am. 2010;92:2445–2451.

    Article  PubMed  Google Scholar 

  17. Gioe TJ, Pomeroy D, Suthers K, Singh JA. Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment. Rheumatology (Oxford). 2009;48:160–164.

    Article  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  19. Khanna G, Singh JA, Pomeroy DL, Gioe TJ. Comparison of patient-reported and clinician-assessed outcomes following total knee arthroplasty. J Bone Joint Surg Am. 2011;93:e117.1–e117.7.

    Article  Google Scholar 

  20. Kwon SK, Kang YG, Kim SJ, Chang CB, Seong SC, Kim TK. Correlations between commonly used clinical outcome scales and patient satisfaction after total knee arthroplasty. J Arthroplasty. 2010;25:1125–1130.

    Article  PubMed  Google Scholar 

  21. Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM. The reliability of the American Knee Society Score. Acta Orthop Scand. 2000;71:603–608.

    Article  PubMed  CAS  Google Scholar 

  22. Lopez-Olivo MA, Landon GC, Siff SJ, Edelstein D, Pak C, Kallen MA, Stanley M, Zhang H, Robinson KC, Suarez-Almazor ME. Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis. 2011;70:1775–1781.

    Article  PubMed  Google Scholar 

  23. Mahomed N, Gandhi R, Daltroy L, Katz JN. The self-administered patient satisfaction scale for primary hip and knee arthroplasty. Arthritis. 2011;2011:591253.

    Article  PubMed  CAS  Google Scholar 

  24. Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP. Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am. 2005;87:1999–2005.

    Article  PubMed  Google Scholar 

  25. Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011;26:728–737.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  27. Noble PC, Scuderi GR, Brekke AC, Sikorskii A, Benjamin JB, Lonner JH, Chadha P, Daylamani DA, Scott WN, Bourne RB. Development of a new Knee Society scoring system. Clin Orthop Relat Res. 2012;470:20–32.

    Article  PubMed  Google Scholar 

  28. Padua R, Ceccarelli E, Bondi R, Campi A, Padua L. Range of motion correlates with patient perception of TKA outcome. Clin Orthop Relat Res. 2007;460:174–177.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  30. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society knee scoring system. Clin Orthop Relat Res. 2012;470:3–19.

    Article  PubMed  Google Scholar 

  31. Sullivan M, Tanzer M, Reardon G, Amirault D, Dunbar M, Stanish W. The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain. 2011;152:2287–2293.

    Article  PubMed  Google Scholar 

  32. Tugwell P, Bombardier C, Buchanan WW, Goldsmith CH, Grace E, Hanna B. The MACTAR Patient Preference Disability Questionnaire—an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol. 1987;14:446–451.

    PubMed  CAS  Google Scholar 

  33. Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

    Article  PubMed  Google Scholar 

  34. Wylde V, Blom AW, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC. Patient-reported outcomes after total hip and knee arthroplasty: comparison of midterm results. J Arthroplasty. 2009;24:210–216.

    Article  PubMed  Google Scholar 

  35. Zisapel N, Nir T. Determination of the minimal clinically significant difference on a patient visual analog sleep quality scale. J Sleep Res. 2003;12:291–298.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Shuichi Matsuda MD

  2. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan

    Shinya Kawahara MD, Ken Okazaki MD, Yasutaka Tashiro MD & Yukihide Iwamoto MD

Authors
  1. Shuichi Matsuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinya Kawahara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Okazaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasutaka Tashiro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukihide Iwamoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuichi Matsuda MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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.

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.

About this article

Cite this article

Matsuda, S., Kawahara, S., Okazaki, K. et al. Postoperative Alignment and ROM Affect Patient Satisfaction After TKA. Clin Orthop Relat Res 471, 127–133 (2013). https://doi.org/10.1007/s11999-012-2533-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2533-y

Keywords

Search

Navigation