Mental Health #1 Factor Affecting Total Knee Satisfaction

Researchers from Cambridge University Hospitals National Health Service Foundation Trust in the UK and the Kobe University Graduate School of Medicine in Japan combed the literature to determine what factors might come into play regarding patient dissatisfaction following a total knee replacement (TKR).

Their work, “Why are patients dissatisfied following a total knee replacement? A systematic review,” was published in the July 8, 2020 edition of International Orthopaedics.

Vikas Khanduja M.A. (Cantab), M.Sc., F.R.C.S. (Orth), a consultant orthopedic surgeon at Addenbrooke’s Hospital, Cambridge and the vice president of the British Hip Society and study co-author, explained the rationale for the review to OTW, “The incidence of patients who have had a knee replacement and remain dissatisfied with their operation is quite high—between 15 to 20%. Therefore we wanted to find out the reasons for the same.”

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the researchers looked at any clinical outcome study that described factors relating to overall satisfaction after primary TKR, finally including 181 articles.

Dr. Khanduja: “Our study reviewed the results of over 100, 000 knee replacements and we found that the following factors influence patient satisfaction following a TKR. A history of mental health problems was the most frequently reported factor affecting patient satisfaction. A negative history of mental health problems, use of a mobile-bearing insert, patellar resurfacing, severe pre-operative radiological degenerative change, negative history of low back pain, no/less post-operative pain, good post-operative physical function and pre-operative expectations being met were considered to be important factors leading to better patient satisfaction following a TKR.”

Decrying the lack of standardization in the determination of patient satisfaction, he told OTW, “Surgeons performing a TKR should take these factors into consderation prior to deciding whether a patient is suitable for a TKR. Secondarily, a detailed explanation of these factors should form part of the process of informed consent to achieve better patient satisfaction following TKR. There is a great need for a unified approach to assessing satisfaction following a TKR and also the time at which satisfaction is assessed.”