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Patient Satisfaction with Total Knee Arthroplasty Differs from Surgeon's

Total knee arthroplasties (TKA), or knee replacements, may need to be revised or replaced in some patients due to malfunction of the hardware or other problems. Doctors have noted that patients who understand the reasons for the initial replacement and the revisions tend to have realistic expectations regarding the outcomes than do those who are not better informed. This can extend to the rate of complications and unexpected outcomes, as well.

Studies have been done that looked into the issue of unexpected complications, however, they are most often performed on patients who underwent hip replacements rather than knee replacements. The authors of this study examined the level of understanding the patients had before the surgery and their level of satisfaction with the revision and the reason for the revision.

Researchers contacted 408 patients who had undergone first-time TKA revisions; 238 patients responded and consented to participate in the study. The patients were asked 10 questions about their experience, which covered topics such as the reason why they went for a revision, what they thought the cause for the revision was, if they had been told about any potential complications, how satisfied they were with the pre-operative reaching, the results of their initial replacement surgery, and how long the replacement lasted before they needed the surgery.

The patients' surgeons were also contacted and were asked the reasons for the revisions. When compiling the data, the researchers included the demographic data, such as age, gender, education, and overall health status.

When reporting the reason for the revision, 38 percent of the patients reported that they were having pain, 25 percent said their knee was unstable, 18 percent said they had an infection, 1 percent experienced a trauma to the knee, and 12 percent had "other reasons." When the surgeons reported their reasons for the revision, they stated that hardware loosening occurred in 40 percent of patients, bone breakdown and loss in 22 percent, instability of the joint in 12 percent, infection in 12 percent, and unknown diagnosis in 3 percent. When asked if the revision was expected, 37 percent of the patients said that it was no expected, but they did know that it could be a complication. Ten percent said the failure was a manufacturing defect or failure, 8 percent said it was due to trauma, 11 percent blamed the surgeon, and 14 percent said it was unknown.

The researchers confirmed patient expectations were indicative of what the outcome was likely to be. The findings suggested that many patients who underwent the revision surgery did not have realistic expectations, with many believing the revision would last longer than their initial replacement. The surgeons, on the other hand, felt differently. When the patients were asked to rate their satisfaction with the education they received before surgery, only 62 percent were satisfied, 19 percent somewhat satisfied, and 19 percent were not satisfied. However, when asked about their satisfaction about the surgery itself, only 51 percent were satisfied, 12 percent somewhat satisfied, and up to 37 percent were not satisfied. When asked to rate their satisfaction regarding how long the TKA worked, only 44 percent were satisfied, 16 percent somewhat satisfied, and 40 percent were unsatisfied.

There was a marked difference between the patients who had to have a revision within 10 years of the initial replacement and those whose revision lasted longer.

The authors of the study point out that there were some limitations, particularly the small participation group and that the questionnaires were asked about events that had already passed. The authors note that there was a wide discrepency between the patient and surgeon about why the initial surgery failed and why the revision was necessary. They concluded that patient education and counseling needs to be realistic and documented in order to ensure the patients understand the risks and causes of failures.


Robert L. Barrack, MD, et al. Revision Total Knee Arthroplasty. In Clinical Orthopaedics and Related Research. November 2007. Vol. 464. Pp. 146-150.

11/21/2007

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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