Elsevier

The Journal of Arthroplasty

Volume 31, Issue 12, December 2016, Pages 2660-2667.e1
The Journal of Arthroplasty

Selected Papers from the 2015 European Knee Society Meeting
A New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2016.06.004Get rights and content

Abstract

Background

Total knee arthroplasty (TKA) is a proven and cost-effective treatment for osteoarthritis. Despite the good to excellent long-term results, some patients remain dissatisfied. Our study aimed at establishing a predictive model to aid patient selection and decision-making in TKA.

Methods

Using data from our prospective arthroplasty outcome database, 113 patients were included. Preoperatively and postoperatively, the patients completed 107 questions in 5 questionnaires: Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, Pain Catastrophizing Scale, Euroqol questionnaire, and Knee Scoring System. First, outcome parameters were compared between the satisfied and dissatisfied group. Second, we developed a new prediction tool using regression analysis. Each outcome score was analyzed with simple regression. Subsequently, the predictive weight of individual questions was evaluated applying multiple linear regression. Finally, 10 questions were retained to construct a new prediction tool.

Results

Overall satisfaction rate in this study was found to be 88%. We identified a significant difference between the satisfied and dissatisfied group when looking at the preoperative questionnaires. Dissatisfied patients had more preoperative symptoms (such as stiffness), less pain, and a lower quality of life. They were more likely to ruminate and had a lower preoperative Knee Scoring System satisfaction score. The developed prediction tool consists of 10 simple but robust questions. Sensitivity was 97% with a positive-predictive value of 93%.

Conclusions

Based upon preoperative parameters, we were able to partially predict satisfaction and dissatisfaction after TKA. After further validation, this new prediction tool for patient satisfaction following TKA may allow surgeons and patients to evaluate the risks and benefits of surgery on an individual basis and help in patient selection.

Section snippets

Materials and Methods

All patients were identified from an established and prospectively collected arthroplasty outcome database at our center, which is in use since 2013 and was specifically developed to evaluate patient-reported outcomes. At the time of analysis, 436 primary TKA patients were included in this database of which 113 met the eligibility criteria outlined hereafter.

(1) Undergoing primary TKA for arthritis (including primary osteoarthritis [OA], rheumatoid arthritis, and posttraumatic OA), (2) ability

Results

The mean age of patients was 65.2 (SD 9.1, range 41-91). Fifty-six percent were female and 50% were right knees. The mean BMI was 29.3 (SD 4.8, range 17-46).

Patient demographics and characteristics are listed in Table 1 and Table 2.

No significant demographic differences were observed between satisfied and dissatisfied patients (Table 3).

Overall satisfaction rate in our study was found to be 88%. Breakdown into different groups according to the possible answers revealed that 41 patients were

Discussion

The overall satisfaction rate of 88% observed in this study is similar to previous reported studies 6, 9. While most other studies dichotomize patient satisfaction in 2 groups, namely satisfied and dissatisfied 6, 20, we consider satisfaction as a continuous variable based on the KSS satisfaction subscore. After categorizing this score into satisfied (a score of ≥20), neutral (score = 20), and dissatisfied (score < 20), 79% was found to be satisfied, 9% neutral, and 12% dissatisfied. However,

Conclusion

We have demonstrated that patient satisfaction at 3 months following TKA is correlated with several preoperative variables including symptoms, pain, awareness of the knee, and anxiety/depression. The development of this new sensitive prediction tool for patient satisfaction following TKA may allow surgeons and patients to evaluate the risks and benefits of surgery on an individual basis. The predictive 10-question score will anticipate on 36% of the postoperative satisfaction with a sensitivity

Acknowledgments

The authors wish to acknowledge Mr. G. Byttebier for his assistance with the statistical analysis.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.06.004.

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