TKA Patients <55: Who Will Be Dissatisfied?

In order to help healthcare providers counsel patients, a team of researchers from Scotland has undertaken a first-of-a-kind study. The work, published in the December edition of The Bone & Joint Journal, was entitled, “Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age.”

Chloe Scott was lead author on the study, and is a consultant trauma and orthopedic surgeon at the Royal Infirmary of Edinburgh in Scotland. She commented to OTW, “The fastest growing users of total knee arthroplasty (TKA) at present are the 45-55 age group. The National Joint Registry of England and Wales has shown this age group to have the highest revision rates. Persistent dissatisfaction may culminate in revision and thus contribute to the elevated revision rate in this age group. To our knowledge there have been no previous reports of patient reported outcome measures, particularly patient dissatisfaction, specifically in this patient population. The aim of this research was to report dissatisfaction following TKA in patients under 55 years old and to identify predictors of this to facilitate patient counseling and expectation management.”

The authors write, “We prospectively assessed 177 TKAs (157 consecutive patients, 99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender, implant, indication, body mass index (BMI), social deprivation, range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis (OA) and prior knee surgery were recorded. Pre- and post-operative Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS) and mental component scores were obtained. Post-operative range of movement, complications and satisfaction were measured at one year.”

Dr. Scott commented to OTW, “For patients under 55 years old with a BMI<40 and knee osteoarthritis occurring in a virgin knee with significant radiographic changes of arthritis (Kellgren-Lawrence grade 3 or 4), dissatisfaction is consistent with previous reports of all ages at 19% dissatisfied at 1 year. Dissatisfaction is highest (59%) in patients with little radiographic OA (K-L grade 1 or 2), but is also twice that expected in patients with multiply operated knees, previous meniscectomies and post-traumatic OA. Postoperatively, stiffness and poor improvement in Oxford Knee Score predict dissatisfaction.”

“The effect of arthroscopic knee surgery, and the timing thereof, on TKA outcomes requires further investigation. As does the effect of the severity of osteoarthritic wear on outcomes following TKA.”