Advertisement

Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature

Published:October 14, 2022DOI:https://doi.org/10.1016/j.arth.2022.10.011

      Abstract

      Background

      Total knee arthroplasty (TKA) is among the most performed orthopaedic surgeries in the United States with at least 1,000,000 cases performed per year. Dissatisfaction following TKA has often been reported as 20% or more, with a multitude of causes including sociodemographic, preoperative, and postoperative factors. The purpose of this study was to re-examine the rate and causes of dissatisfaction following TKA.

      Methods

      A systematic review of the literature was performed searching databases from 2010 to 2022. Only primary TKA cases were included and all cases of unicompartmental arthroplasty and revisions were excluded. After abstracts were reviewed, 35 articles were selected for a full-length review, which was ultimately reduced to 21 articles for final inclusion.

      Results

      The average rate of patient dissatisfaction was 10%. Excluding complications, the average rate of dissatisfaction was 7.3%. The most common sociodemographic factors for dissatisfaction were age < 65 years, lower income, and non-White patients. Preoperative factors included lower Kellgren-Lawrence scores, depression/anxiety, and pain catastrophizing. Postoperatively, most dissatisfaction was due to complications, unmet expectations, persistent pain, and stiffness.

      Conclusion

      Based on our review, the average rate of patient dissatisfaction following TKA is 10%. Improved counseling for known risk factors may have reduced dissatisfaction rates by increasing preoperative patient optimization. Many studies in recent years have demonstrated the issue of poor patient coping skills, such as pain catastrophizing and anxiety/depression as a common cause of dissatisfaction. Ultimately, dissatisfaction following TKA still continues to affect a high portion of patients but less than historical reports of 20%.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Singh J.A.
        • Yu S.
        • Chen L.
        • Cleveland J.D.
        Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample.
        J Rheumatol. 2019; 46: 1134-1140https://doi.org/10.3899/jrheum.170990
        • Dowsey M.M.
        • Choong P.F.M.
        The utility of outcome measures in total knee replacement surgery.
        Int J Rheumatol. 2013; 2013: 1-8https://doi.org/10.1155/2013/506518
        • Bourne R.B.
        • Chesworth B.M.
        • Davis A.M.
        • Mahomed N.N.
        • Charron K.D.J.
        Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?.
        Clin Orthop Relat Res. 2010; 468: 57-63https://doi.org/10.1007/s11999-009-1119-9
        • Noble P.C.
        • Conditt M.A.
        • Cook K.F.
        • Mathis K.B.
        The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty.
        Clin Orthop Relat Res. 2006; 452: 35-43https://doi.org/10.1097/01.blo.0000238825.63648.1e
        • Baker P.N.
        • van der Meulen J.H.
        • Lewsey J.
        • Gregg P.J.
        The role of pain and function in determining patient satisfaction after total knee replacement: data from the National Joint Registry for England and Wales.
        J Bone Joint Surg Br. 2007; 89-B: 893-900https://doi.org/10.1302/0301-620X.89B7.19091
        • 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
        • Gunaratne R.
        • Pratt D.N.
        • Banda J.
        • Fick D.P.
        • Khan R.J.K.
        • Robertson B.W.
        Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature.
        J Arthroplasty. 2017; 32: 3854-3860https://doi.org/10.1016/j.arth.2017.07.021
        • Likert R.
        A technique for the measurement of attitudes.
        Arch Psychol. 1932; 22: 55
        • Khatib Y.
        • Badge H.
        • Xuan W.
        • Naylor J.M.
        • Harris I.A.
        Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 3156-3163https://doi.org/10.1007/s00167-019-05804-9
        • Leppänen S.
        • Niemeläinen M.
        • Huhtala H.
        • Eskelinen A.
        Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up.
        BMC Musculoskelet Disord. 2021; 22: 657https://doi.org/10.1186/s12891-021-04543-8
        • Nam D.
        • Nunley R.M.
        • Barrack R.L.
        Patient dissatisfaction following total knee replacement: a growing concern?.
        Bone Joint J. 2014; 96-B: 96-100https://doi.org/10.1302/0301-620X.96B11.34152
        • Ayers D.C.
        • Yousef M.
        • Zheng H.
        • Yang W.
        • Franklin P.D.
        The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
        J Arthroplasty. 2022; 37: S121-S128https://doi.org/10.1016/j.arth.2022.02.077
        • Orr M.N.
        • Klika A.K.
        • Emara A.K.
        • Piuzzi N.S.
        Combinations of preoperative patient-reported outcome measure phenotype (pain, function, and mental health) predict outcome after total knee arthroplasty.
        J Arthroplasty. 2022; 37: S110-S120.e5https://doi.org/10.1016/j.arth.2022.02.090
        • Kunze K.N.
        • Polce E.M.
        • Sadauskas A.J.
        • Levine B.R.
        Development of machine learning algorithms to predict patient dissatisfaction after primary total knee arthroplasty.
        J Arthroplasty. 2020; 35: 3117-3122https://doi.org/10.1016/j.arth.2020.05.061
        • Huijbregts H.J.T.A.M.
        • Khan R.J.K.
        • Fick D.P.
        • Jarrett O.M.
        • Haebich S.
        Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score.
        Knee. 2016; 23: 535-539https://doi.org/10.1016/j.knee.2015.12.007
        • Pronk Y.
        • Peters M.C.W.M.
        • Brinkman J.M.
        Is patient satisfaction after total knee arthroplasty predictable using patient characteristics and preoperative patient-reported outcomes?.
        J Arthroplasty. 2021; 36: 2458-2465https://doi.org/10.1016/j.arth.2021.02.064
        • Dhurve K.
        • Scholes C.
        • El-Tawil S.
        • Shaikh A.
        • Weng L.K.
        • Levin K.
        • et al.
        Multifactorial analysis of dissatisfaction after primary total knee replacement.
        Knee. 2017; 24: 856-862https://doi.org/10.1016/j.knee.2017.04.005
        • Scott C.E.H.
        • Oliver W.M.
        • MacDonald D.
        • Wade F.A.
        • Moran M.
        • Breusch S.J.
        Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age.
        Bone Joint J. 2016; 98-B: 1625-1634https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0375.R1
        • Van Onsem S.
        • Van Der Straeten C.
        • Arnout N.
        • Deprez P.
        • Van Damme G.
        • Victor J.
        A new prediction model for patient satisfaction after total knee arthroplasty.
        J Arthroplasty. 2016; 31: 2660-2667.e1https://doi.org/10.1016/j.arth.2016.06.004
        • Clement N.D.
        • Bardgett M.
        • Weir D.
        • Holland J.
        • Gerrand C.
        • Deehan D.J.
        Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late.
        Bone Joint J. 2018; 100-B: 161-169https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-1016.R1
        • Scott C.E.H.
        • Howie C.R.
        • MacDonald D.
        • Biant L.C.
        Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients.
        J Bone Joint Surg Br. 2010; 92-B: 1253-1258https://doi.org/10.1302/0301-620X.92B9.24394
        • Clement N.D.
        • MacDonald D.
        • Simpson A.H.R.W.
        • Burnett R.
        Total knee replacement in patients with concomitant back pain results in a worse functional outcome and a lower rate of satisfaction.
        Bone Joint J. 2013; 95-B: 1632-1639https://doi.org/10.1302/0301-620X.95B12.31684
        • Schnurr C.
        • Jarrous M.
        • Güdden I.
        • Eysel P.
        • König D.P.
        Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction.
        Int Orthop (Sicot). 2013; 37: 1257-1261https://doi.org/10.1007/s00264-013-1862-0
        • Ali A.
        • Lindstrand A.
        • Sundberg M.
        • Flivik G.
        Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up.
        J Arthroplasty. 2017; 32: 767-770https://doi.org/10.1016/j.arth.2016.08.033
        • Lin Y.
        • Chen X.
        • Li L.
        • Li Z.
        • Zhang Y.
        • Fan P.
        Comparison of patient satisfaction between medial pivot prostheses and posterior-stabilized prostheses in total knee arthroplasty.
        Orthop Surg. 2020; 12: 836-842https://doi.org/10.1111/os.12687
        • Ghomrawi H.M.K.
        • Lee L.Y.
        • Nwachukwu B.U.
        • Wright T.
        • Padgett D.
        • Bozic K.J.
        • et al.
        Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study.
        J Am Acad Orthop Surg. 2020; 28: e145-e150https://doi.org/10.5435/JAAOS-D-18-00785
        • Clement N.D.
        • Burnett R.
        Patient satisfaction after total knee arthroplasty is affected by their general physical well-being.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2638-2646https://doi.org/10.1007/s00167-013-2523-y