Download PDF
J Knee Surg 2011; 24(1): 019-024
DOI: 10.1055/s-0031-1275389
SPECIAL FOCUS SECTION

© Thieme Medical Publishers

Maximizing Patient Satisfaction and Functional Results After Total Knee Arthroplasty

Kenneth A. Greene1 , Steven F. Harwin2 , 3
  • 1Department of Orthopaedic Surgery, Northeast Ohio Universities College of Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio
  • 2Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York
  • 3Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York
Further Information

Publication History

Publication Date:
22 March 2011 (online)

    Permissions and Reprints

ABSTRACT

The purpose of this article is to review the issues regarding preoperative patient expectations for total knee arthroplasty and whether or not these are fulfilled after surgery. The demographics of the typical total knee arthroplasty patient are changing, and the expectations regarding the outcome of the surgery have been changing as well. Patients are younger, heavier, more active, and often come to the surgeon's office with information provided via the Internet that may be inaccurate and/or misleading. Many expect and assume that the operation will return the knee to “normal.” Traditional outcomes measures used by orthopedic surgeons to determine the quality of the results achieved are inadequate and do not take into account the higher expectations of current patients. Various strategies have been developed to improve satisfaction after the surgery. These include preoperative patient education, less invasive surgical approaches, advances in prosthetic design, multimodal pain management, and aggressive postoperative rehabilitation. Using these strategies will make preoperative expectations more realistic and improve postoperative satisfaction.

KEYWORDS

Total knee - outcomes - satisfaction - expectations - range of motion

REFERENCES

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.  J Bone Joint Surg Am. 2007;  89 780-785
    CrossrefPubMedGoogle Scholar
  • 2 Scott C E, 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 1253-1258
    CrossrefPubMedGoogle Scholar
  • 3 Noble P C, Gordon M J, Weiss J M, Reddix R N, Conditt M A, Mathis K B. Does total knee replacement restore normal knee function?.  Clin Orthop Relat Res. 2005;  (431) 157-165
    PubMedGoogle Scholar
  • 4 Wylde V, Blom A W, Whitehouse S L, Taylor A H, Pattison G T, Bannister G C. Patient-reported outcomes after total hip and knee arthroplasty: Comparison of midterm results.  J Arthroplasty. 2009;  24 210-216
    CrossrefPubMedGoogle Scholar
  • 5 Bourne R B, 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
    CrossrefPubMedGoogle Scholar
  • 6 Kwon S K, Kang Y G, Kim S J, Chang C B, Seong S C, Kim T K. Correlations between commonly used clinical outcome scales and patient satisfaction after total knee arthroplasty.  J Arthroplasty. 2010;  25 1125-1130
    CrossrefPubMedGoogle Scholar
  • 7 Mason J B. The new demands by patients in the modern era of total joint arthroplasty: A point of view.  Clin Orthop Relat Res. 2008;  466 (1) 146-152
    CrossrefPubMedGoogle Scholar
  • 8 Healy W L, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty.  J Bone Joint Surg Am. 2008;  90 2245-2252
    CrossrefPubMedGoogle Scholar
  • 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 35-43
    CrossrefPubMedGoogle Scholar
  • 10 Bourne R B, Chesworth B M, Davis A M, Mahomed N N, Charron K D. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not?.  Clin Orthop Relat Res. 2010;  468 57-63
    CrossrefPubMedGoogle Scholar
  • 11 Gandhi R, Davey J R, Mahomed N N. Predicting patient dissatisfaction following joint replacement surgery.  J Rheumatol. 2008;  35 2415-2418
    CrossrefPubMedGoogle Scholar
  • 12 Scott C E, 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 1253-1258
    CrossrefPubMedGoogle Scholar
  • 13 Brander V, Gondek S, Martin E, Stulberg S D. Pain and depression influence outcome 5 years after knee replacement surgery.  Clin Orthop Relat Res. 2007;  464 21-26
    Google Scholar
  • 14 Mannion A F, Kämpfen S, Munzinger U, Kramers-de Quervain I. The role of patient expectations in predicting outcome after total knee arthroplasty.  Arthritis Res Ther. 2009;  11 R139
    CrossrefPubMedGoogle Scholar
  • 15 Franklin P D, Li W, Ayers D C. The Chitranjan Ranawat Award: Functional outcome after total knee replacement varies with patient attributes.  Clin Orthop Relat Res. 2008;  466 2597-2604
    CrossrefPubMedGoogle Scholar
  • 16 Jacobson A F, Myerscough R P, Delambo K et al.. Patients' perspectives on total knee replacement.  Am J Nurs. 2008;  108 54-63; quiz 63–64
    PubMedGoogle Scholar
  • 17 NIH Consensus Statement on total knee replacement.  NIH Consens State Sci Statements. 2003;  20 1-34
    PubMedGoogle Scholar
  • 18 Walter F L, Bass N, Bock G, Markel D C. Success of clinical pathways for total joint arthroplasty in a community hospital.  Clin Orthop Relat Res. 2007;  457 133-137
    PubMedGoogle Scholar
  • 19 Kim T K, Chang C B, Kang Y G, Kim S J, Seong S C. Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty.  J Arthroplasty. 2009;  24 263-271
    CrossrefPubMedGoogle Scholar
  • 20 Tsuji S, Tomita T, Fujii M, Laskin R S, Yoshikawa H, Sugamoto K. Is minimally invasive surgery-total knee arthroplasty truly less invasive than standard total knee arthroplasty? A quantitative evaluation.  J Arthroplasty. 2010;  25 970-976
    CrossrefPubMedGoogle Scholar
  • 21 Wülker N, Lambermont J P, Sacchetti L, Lazaró J G, Nardi J. A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery.  J Bone Joint Surg Am. 2010;  92 1584-1590
    CrossrefPubMedGoogle Scholar
  • 22 Chen A F, Alan R K, Redziniak D E, Tria Jr A J. Quadriceps sparing total knee replacement. The initial experience with results at two to four years.  J Bone Joint Surg Br. 2006;  88 1448-1453
    CrossrefPubMedGoogle Scholar
  • 23 Barrack R L, Barnes C L, Burnett R S, Miller D, Clohisy J C, Maloney W J. Minimal incision surgery as a risk factor for early failure of total knee arthroplasty.  J Arthroplasty. 2009;  24 489-498
    CrossrefPubMedGoogle Scholar
  • 24 Eckhoff D G, Bach J M, Spitzer V M et al.. Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality.  J Bone Joint Surg Am. 2005;  87 (Suppl 2) 71-80
    CrossrefPubMedGoogle Scholar
  • 25 Mahoney O M, Kinsey T L. 5- to 9-year survivorship of single-radius, posterior-stabilized TKA.  Clin Orthop Relat Res. 2008;  466 436-442
    CrossrefPubMedGoogle Scholar
  • 26 Harwin S F, Kester M. Single radius total knee arthroplasty: PCL sacrifice without substitution yields excellent outcomes minimum 8-year follow-up.  Surg Technol Int. 2010;  19 191-198
    PubMedGoogle Scholar
  • 27 Greene K A, Schurman II J R. Quadriceps muscle function in primary total knee arthroplasty.  J Arthroplasty. 2008;  23 (7, Suppl) 15-19
    PubMedGoogle Scholar
  • 28 Wang H, Simpson K J, Ferrara M S, Chamnongkich S, Kinsey T, Mahoney O M. Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii.  J Arthroplasty. 2006;  21 1193-1199
    CrossrefPubMedGoogle Scholar
  • 29 Gómez-Barrena E, Fernandez-García C, Fernandez-Bravo A, Cutillas-Ruiz R, Bermejo-Fernandez G. Functional performance with a single-radius femoral design total knee arthroplasty.  Clin Orthop Relat Res. 2010;  468 1214-1220
    CrossrefPubMedGoogle Scholar
  • 30 McCalden R W, MacDonald S J, Bourne R B, Marr J T. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty.  J Arthroplasty. 2009;  24 (6, Suppl) 33-38
    PubMedGoogle Scholar
  • 31 Mehin R, Burnett R S, Brasher P M. Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis.  J Bone Joint Surg Br. 2010;  92 1429-1434
    CrossrefPubMedGoogle Scholar
  • 32 Harwin S F, Greene K A, Hitt K. Triathlon total knee arthroplasty: 4-year outcomes with a high-performance implant.  J Knee Surg. 2008;  21 320-326
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 McCalden R W, MacDonald S J, Charron K D, Bourne R B, Naudie D D. The role of polyethylene design on postoperative TKA flexion: an analysis of 1534 cases.  Clin Orthop Relat Res. 2010;  468 108-114
    CrossrefPubMedGoogle Scholar
  • 34 Maheshwari A V, Blum Y C, Shekhar L, Ranawat A S, Ranawat C S. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center.  Clin Orthop Relat Res. 2009;  467 1418-1423
    CrossrefPubMedGoogle Scholar
  • 35 Kadic L, Boonstra M C, DE Waal Malefijt M C, Lako S J, VAN Egmond J, Driessen J J. Continuous femoral nerve block after total knee arthroplasty?.  Acta Anaesthesiol Scand. 2009;  53 914-920
    CrossrefPubMedGoogle Scholar
  • 36 Kandasami M, Kinninmonth A W, Sarungi M, Baines J, Scott N B. Femoral nerve block for total knee replacement - a word of caution.  Knee. 2009;  16 98-100
    CrossrefPubMedGoogle Scholar
  • 37 Sharma S, Iorio R, Specht L M, Davies-Lepie S, Healy W L. Complications of femoral nerve block for total knee arthroplasty.  Clin Orthop Relat Res. 2010;  468 135-140
    CrossrefPubMedGoogle Scholar
  • 38 Kolisek F R, Gilmore K J, Peterson E K. Slide and flex, tighten, extend (SAFTE): A safe, convenient, effective, and no-cost approach to rehabilitation after total knee arthroplasty.  J Arthroplasty. 2000;  15 1013-1016
    CrossrefPubMedGoogle Scholar
  • 39 Ritter M A, Campbell E D. Effect of range of motion on the success of a total knee arthroplasty.  J Arthroplasty. 1987;  2 95-97
    CrossrefPubMedGoogle Scholar
  • 40 Lizaur A, Marco L, Cebrian R. Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis.  J Bone Joint Surg Br. 1997;  79 626-629
    CrossrefPubMedGoogle Scholar

Kenneth A GreeneM.D. 

Professor of Orthopaedic Surgery, Northeast Ohio Universities College of Medicine and Pharmacy, Cleveland Clinic

9500 Euclid Avenue A/41, Cleveland, OH 44195

Email: greenek2@ccf.org

      >