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Fulfillment of expectations influence patient satisfaction 5 years after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Constant efforts have been made to improve prosthesis design in total knee arthroplasty (TKA), but a significant number of patients remain dissatisfied postoperatively. Besides poor improvement in pain or function, poor fulfillment of patients expectations were identified as contributing factors. Purpose of the study was to assess fulfillment of patients’ expectations and satisfaction with TKA 5 years after surgery.

Methods

A total of 103 patients from a prospective randomised study of a high-flexion or standard TKA implant were investigated 5 years after surgery and patient-reported outcomes (PRO), fulfillment of expectations and satisfaction with the result of the surgery were obtained.

Results

There were no differences in PROs, fulfillment of expectations and satisfaction between both implant designs. In total, the patients had high expectations preoperatively, mainly related to pain relief and functional abilities. A total of 89.4% of these expectations were fulfilled. No re-interventions (p < 0.001) and male gender (p = 0.017) were the most important predictors of higher fulfillment of expectations. Satisfaction scored highly at 8.2 out of 10 and most patients (93.2%) would undergo the surgery again. Higher Knee Score (p = 0.012) and fulfillment of expectations (p = 0.002) were correlated with higher satisfaction.

Conclusion

Five years after surgery fulfillment of expectations and satisfaction were high regardless of implant design and did significantly influence patient satisfaction. Surgeons should be aware of the importance of patients’ expectations and their influence on satisfaction after TKA. Therefore, the probability of fulfillment should be discussed during shared decision making for TKA.

Level of evidence

I.

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Abbreviations

ADL:

Activities of daily living

ASA:

American Society of Anesthesiologists physical status classification

BMI:

Body mass index

e.g.:

Exempli gratia (for example)

et al.:

Et alia

HHS-HRES:

Hospital for Special Surgery Hip Replacement Expectations Survey

HHS-KRES:

Hospital for Special Surgery Knee Replacement Expectations Survey

HRQoL:

Health-related quality of life

IL:

Illinois

Inc:

Incorporated

KSS:

Knee Society Score

KS-FS:

Function Score

KS–KS:

Knee Score

MCS:

Mental Component Score (SF-36)

NJ:

New Jersey

n.s.:

Not significant

PCC:

Pearson correlation coefficient

PCS:

Physical Component Score (SF-36)

PRO:

Patient-reported outcome

PROM:

Patient-reported outcomes measures

SD:

Standard deviation

SF-36:

Short-Form 36

TKA:

Total knee arthroplasty

VAS:

Visual analogue scale

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Acknowledgements

The authors thank Brit Brethfeld and Anne Schützer for her valuable assistance during follow-up and data management.

Funding

The 5-year follow-up was supported by Deutsche Arthrosehilfe. The initial study was funded by Stryker (Mahwah, NJ, USA).

Author information

Authors and Affiliations

Authors

Contributions

SK and JL have been involved in planning, AP, CL, SK and JL in the execution, FB, CL and JL in the analysis of this study. CL and AP have written the draft and all authors have corrected the manuscript. Both first authors (CL and AP) have equally contributed to the manuscript.

Corresponding author

Correspondence to Jörg Lützner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been performed in compliance with the Helsinki Declaration and has been approved by the ethics committee of the TU Dresden (EK 3012015).

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Lützner, C., Postler, A., Beyer, F. et al. Fulfillment of expectations influence patient satisfaction 5 years after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 2061–2070 (2019). https://doi.org/10.1007/s00167-018-5320-9

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