Patient Satisfaction Following Primary Total Knee Arthroplasty: Contributing Factors

Document Type : CURRENT CONCEPTS REVIEW

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

Abstract

The reported dissatisfaction rate after primary total knee arthroplasty (TKA) ranges between 15% and 25%. The purpose
of this article is to perform a narrative review of the literature with the aim of answering the following question: What are
the main factors contributing to patient dissatisfaction after TKA? A review of the literature was performed on patient
satisfaction after TKA. The search engines used were MedLine (PubMed) and the Cochrane Library. The keywords used
were “TKA” and “satisfaction”. The main reported preoperative factors positively contributing to patient satisfaction were
the following: fulfilment of preoperative expectations, preoperative complete joint space collapse, increasing patellar and
lateral compartment osteophyte size, and TKA communication checklist. The principal preoperative factors negatively
contributing to patient satisfaction included female sex, comorbidities, and Hispanic race. The chief perioperative factor
positively contributing to patient satisfaction was cosmetic closure, whereas the fundamental perioperative factors
negatively contributing to patient satisfaction included joint laxity, anterior tibial component slope, and greater femoral
component valgus angle. The principal postoperative factors positively contributing to patient satisfaction were the
following: ameliorated walking distance, improved range of motion, and improvements in pain. The most important
postoperative factors negatively contributing to patient satisfaction included poor postoperative knee stability and softtissue
balance, functional limitation, surgical complication and reoperation, staff or quality of care issues, and increased
stiffness.
Level of evidence: III

Keywords


1. Calkins TE, Culvern C, Nahhas CR, Della Valle CJ,
Gerlinger TL, Levine BR, et al. External validity of
a new prediction model for patient satisfaction
after total knee arthroplasty. J Arthroplasty.
2019;34(8):1677-81.
2. Bierke S, Häner M, Karpinski K, Hees T, Petersen W.
Midterm effect of mental factors on pain, function,
and patient satisfaction 5 years after uncomplicated
total knee arthroplasty. J Arthroplasty. 2020; 35(1):
105-11.
3. Huang Y, Lee M, Chong HC, Ning Y, Lo NN, Yeo
SJ. Reasons and factors behind post-total knee
arthroplasty dissatisfaction in an Asian population.
Ann Acad Med Singapore. 2017; 46(8):303-9.
4. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK,
Robertson BW. Patient dissatisfaction following
total knee arthroplasty: A systematic review of the
literature. J Arthroplasty. 2017; 32(12):3854-60.
5. Alosh H, Behery OA, Levine BR. Radiographic
predictors of patient satisfaction following primary
total knee arthroplasty. Bull Hosp Jt Dis (2013).
2018; 76(2):105-11.
6. Walker LC, Clement ND, Bardgett M, Weir D, Holland
J, Gerrand C,et al. The WOMAC score can be reliably
used to classify patient satisfaction after total knee
arthroplasty. Knee Surg Sports Traumatol Arthrosc.
2018; 26(11):3333-41.
7. Hasegawa M, Naito Y, Yamaguchi T, Wakabayashi H,
Sudo A. Factors contributing to patient satisfaction
and expectations following computer-assisted total
Knee arthroplasty. J Knee Surg. 2018;31(5):448-52.
8. Lange JK, Lee YY, Spiro SK, Haas SB. Satisfaction
rates and quality of life changes following total
knee arthroplasty in age-differentiated cohorts. J
Arthroplasty. 2018; 33(5):1373-8.
9. Ware J Jr, Kosinski M, Keller S D. A 12-Item shortform
health survey: Construction of scales and
preliminary tests of reliability and validity. Medical
Care 1996; 34(3):220-33.
10. Clement ND, Bardgett M, Weir D, Holland J, Gerrand
C, Deehan DJ. The rate and predictors of patient
satisfaction after total knee arthroplasty are
influenced by the focus of the question: a standard
satisfaction question is required. Bone Joint J. 2018;
100-B (6):740-8.
11. American College of Rheumatology. Western
Ontario and McMaster Universities Osteoarthritis
Index (WOMAC). http://www.rheumatology.org/
practice/clinical/clinicianresearchers/outcomesinstrumentation/
WOMAC.asp. (accessed 12 July
2013).
12. Gautreau SJ, Gould ON, Allanach WW, Clark AE,
Massoeurs SJ, Forsythe ME. Total knee arthroplasty
communication checklist increases patient satisfaction.
J Arthroplasty. 2019; 34(3):456-61.
13. Halawi MJ, Jongbloed W, Baron S, Savoy L, Williams
VJ, Cote MP. Patient dissatisfaction after primary
total joint arthroplasty: The patient perspective. J
Arthroplasty. 2019; 34(6):1093-6.
14. Deakin AH, Smith MA, Wallace DT, Smith EJ, Sarungi
M. Fulfilment of preoperative expectations and
postoperative patient satisfaction after total knee
replacement. A prospective analysis of 200 patients.
The Knee. 2019; 26(6):1403-12.
15. Felix J, Becker C, Vogl M, Buschner P, Plötz W,
Leidl R. Patient characteristics and valuation
changes impact quality of life and satisfaction in
total knee arthroplasty - results from a German
prospective cohort study. Health Qual Life Outcomes.
2019;17(1):180.
16. Liebensteiner M, Wurm A, Gamper D, Oberaigner
W, Dammerer D, Krismer M. Patient satisfaction
after total knee arthroplasty is better in patients
with preoperative complete joint space collapse. Int
Orthop. 2019;43(8):1841-7.
17. Johnson MR, Singh JA, Stewart T, Gioe TJ. Patient
understanding and satisfaction in informed consent
for total knee arthroplasty: A randomized study.
Arthritis Care & Research 2011; 63(7):1048‐54.
18. Jain D, Nguyen LCL, Bendich I, Nguyen LL, Lewis
CG, Huddleston JI, et al. Higher patient expectations
predict higher patient-reported outcomes, but not
satisfaction, in total knee arthroplasty patients:
A prospective multicenter study. J Arthroplasty
2017;32(9S):S166-S170.
19. Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura
S, Furu M, Ito H, et al. Medial rather than lateral
knee instability correlates with inferior patient
satisfaction and knee function after total knee
arthroplasty. Knee. 2017;24(6):1478-84.
20. Azukizawa M, Kuriyama S, Nakamura S, Nishitani K,
Lyman S, Morita Y, Furu M et al. Intraoperative medial
joint laxity in flexion decreases patient satisfaction
after total knee arthroplasty. Arch Orthop Trauma
Surg. 2018;138(8):1143-50.
21. Kamenaga T, Muratsu H, Kanda Y, Miya H, Kuroda
R, Matsumoto T. The influence of postoperative
knee stability on patient satisfaction in cruciateretaining
total knee arthroplasty. J Arthroplasty.
2018;33(8):2475-9.
22. Agarwala S, Vijayvargiya M. Concealed cosmetic
closure in total knee replacement surgery - A
prospective audit assessing appearance and patient
satisfaction. J Clin Orthop Trauma. 2019;10(1):111-6.
23. Sundaram K, Piuzzi NS, Patterson BM, Stearns
KL, Krebs VE, Mont MA. Skin closure with 2-octyl
cyanoacrylate and polyester mesh after primary
total knee arthroplasty offers superior cosmetic
outcomes and patient satisfaction compared to
staples: a prospective trial. European Journal
of Orthopaedic Surgery & Traumatology. 2020;
30(3):447-53.
24. Khlopas A, Sodhi N, Hozack WJ, Chen AF, Mahoney
OM, Kinsey T, et al. Patient-reported functional and
satisfaction outcomes after robotic-arm-assisted
total knee arthroplasty: early results of a prospective
multicenter investigation. The journal of knee
surgery. 2020;33(07):685-90.
25. Reimann P, Brucker M, Arbab D, Lüring C. Patient
satisfaction - A comparison between patient-specific
implants and conventional total knee arthroplasty. J
Orthop. 2019;16(3):273-7.
26. Smith AF, Eccles CJ, Bhimani SJ, Denehy KM, Bhimani
RB, Smith LS, et al. Improved patient satisfaction
following robotic-assisted Total knee Arthroplasty.
The journal of knee surgery. 2019.
27. Galea VP, Rojanasopondist P, Connelly JW, Bragdon
CR, Huddleston JI 3rd, Ingelsrud LH, et al. Changes in
patient satisfaction following total joint arthroplasty.
J Arthroplasty. 2020;35(1):32-8.
28. Moghtadaei M, Farahini H, Faiz SH, Mokarami F, Safari
S. Pain management for total knee arthroplasty:
single-injection femoral nerve block versus local
infiltration analgesia. Iran Red Crescent Med J.
2014;16(1):e13247.
29. Hitt KD, Pierce TP, Jauregui JJ, Cherian JJ, Elmallah RD,
Leibowitz E, et al. Use of a flexible intramedullary rod
and its influence on patient satisfaction and femoral
size in total knee arthroplasty. J Long Term Eff Med
Implants 2015; 25(3):201‐8.
30. Shannak O, Palan J, Esler C. A regional registry study
of 216 patients investigating if patient satisfaction
after total knee arthroplasty changes over a time
period of five to 20 years. Knee. 2017;24(4):824-8.
31. Van Onsem S, Verstraete M, Dhont S, Zwaenepoel
B, Van Der Straeten C, Victor J. Improved walking
distance and range of motion predict patient
satisfaction after TKA. Knee Surg Sports Traumatol
Arthrosc. 2018;26(11):3272-9.
32. Bryan S, Goldsmith LJ, Davis JC, Hejazi S, MacDonald
V, McAllister P, et al. Revisiting patient satisfaction
following total knee arthroplasty: A longitudinal
observational study. BMC Musculoskelet Disord.
2018;19(1):423.
33. Clement ND, Bardgett M, Weir D, Holland J, Deehan
DJ. Increased symptoms of stiffness 1 year after
total knee arthroplasty are associated with a worse
functional outcome and lower rate of patient
satisfaction. Knee Surg Sports Traumatol Arthrosc.
2019;27(4):1196-1203.
34. Moffet H, Tousignant M, Nadeau S, Mérette C, Boissy
P, Corriveau H, et al. Patient satisfaction with inhome
telerehabilitation after total knee arthroplasty:
Results from a randomized controlled trial. Telemed
J E Health 2017; 23(3):80‐7.
35. Kobayashi S, Niki Y, Harato K, Nagura T, Nakamura M,
Matsumoto M. Rheumatoid arthritis patients achieve
better satisfaction but lower functional activities as
compared to osteoarthritis patients after total knee
arthroplasty. J Arthroplasty. 2019;34(3):478-482.e1
36. Lützner C, Postler A, Beyer F, Kirschner S,
Lützner J. Fulfillment of expectations influence
patient satisfaction 5 years after total knee
arthroplasty. Knee Surg Sports Traumatol Arthrosc.
2019;27(7):2061-70.
37. Clement ND, Merrie KL, Weir DJ, Holland JP, Deehan
DJ. Asynchronous bilateral total knee arthroplasty:
Predictors of the functional outcome and patient
satisfaction for the second knee replacement. J
Arthroplasty. 2019;34(12):2950-6.
38. Kunze KN, Akram F, Fuller BC, Zabawa L, Sporer SM,
Levine BR. Internal validation of a predictive model
for satisfaction after primary total knee arthroplasty.
J Arthroplasty. 2019;34(4):663-70.
39. Zabawa L, Li K, Chmell S. Patient dissatisfaction
following total knee arthroplasty: External
validation of a new prediction model. Eur J Orthop
Surg Traumatol. 2019;29(4):861-7.