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Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late.
Bone Joint J. 2018 Feb; 100-B(2):161-169.BJ

Abstract

AIMS

The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year.

PATIENTS AND METHODS

A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years.

RESULTS

The overall rate of satisfaction did not change from one (91.7%, n = 1255) to five (90.1%, n = 1234) years (p = 0.16). Approximately half (n = 53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n = 74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p = 0.04), with depression (p = 0.001), with back pain (p < 0.001), undergoing unilateral TKA (p = 0.001), or with a worse preoperative WOMAC pain score (p = 0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p = 0.04) and a worse WOMAC stiffness score (p = 0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p = 0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years.

CONCLUSION

Three groups of dissatisfied patients exist after TKA: 'early' dissatisfaction at one year, 'persistent' dissatisfaction with longer follow-up, and 'late' dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction. Cite this article: Bone Joint J 2018;100-B:161-9.

Authors+Show Affiliations

Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DD, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29437057

Citation

Clement, N D., et al. "Three Groups of Dissatisfied Patients Exist After Total Knee Arthroplasty: Early, Persistent, and Late." The Bone & Joint Journal, vol. 100-B, no. 2, 2018, pp. 161-169.
Clement ND, Bardgett M, Weir D, et al. Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. Bone Joint J. 2018;100-B(2):161-169.
Clement, N. D., Bardgett, M., Weir, D., Holland, J., Gerrand, C., & Deehan, D. J. (2018). Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. The Bone & Joint Journal, 100-B(2), 161-169. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-1016.R1
Clement ND, et al. Three Groups of Dissatisfied Patients Exist After Total Knee Arthroplasty: Early, Persistent, and Late. Bone Joint J. 2018;100-B(2):161-169. PubMed PMID: 29437057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. AU - Clement,N D, AU - Bardgett,M, AU - Weir,D, AU - Holland,J, AU - Gerrand,C, AU - Deehan,D J, PY - 2018/2/14/entrez PY - 2018/2/14/pubmed PY - 2018/2/17/medline KW - Outcome KW - Patient dissatisfaction KW - Patient satisfaction KW - Predictor KW - Total knee arthroplasty SP - 161 EP - 169 JF - The bone & joint journal JO - Bone Joint J VL - 100-B IS - 2 N2 - AIMS: The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year. PATIENTS AND METHODS: A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years. RESULTS: The overall rate of satisfaction did not change from one (91.7%, n = 1255) to five (90.1%, n = 1234) years (p = 0.16). Approximately half (n = 53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n = 74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p = 0.04), with depression (p = 0.001), with back pain (p < 0.001), undergoing unilateral TKA (p = 0.001), or with a worse preoperative WOMAC pain score (p = 0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p = 0.04) and a worse WOMAC stiffness score (p = 0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p = 0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years. CONCLUSION: Three groups of dissatisfied patients exist after TKA: 'early' dissatisfaction at one year, 'persistent' dissatisfaction with longer follow-up, and 'late' dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction. Cite this article: Bone Joint J 2018;100-B:161-9. SN - 2049-4408 UR - https://www.unboundmedicine.com/medline/citation/29437057/Three_groups_of_dissatisfied_patients_exist_after_total_knee_arthroplasty:_early_persistent_and_late_ L2 - https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.100B2.BJJ-2017-1016.R1?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -