Discrepant histological diagnoses affects the near term FJS-12 and could be one of the causes of unhappy TKR patient

Abstract

Introduction:TKR is one of the most successful operations in orthopedics. Still a sizable percentage of patients (20%) remain dissatisfied after a well executed TKR. The aim of the study is to examine the excised synovium from the suprapatellar region in osteoarthritic knees during TKR operation and evaluate the HP report to know whether discrepant diagnoses affects the Forgotten Joint Score-12 at various time intervals and in few cases the unrelenting pain and discomfort post TKR surgery could be due to some undiagnosed pathology within the joint.Hypotheses:The study was started with null hypothesis. The statistical significance was measured with Chi-square test and two sample t test.Methods:This is a prospective cohort study. Two hundred(160 Female 40 Male) end stage osteoarthritis patients who underwent primary TKR were studied. Inclusion criteria was patient with end stage osteoarthritis. Patients with clinically and serologically proven rheumatoid arthritis were excluded. The synovium excised during the TKR procedure was sent for HP examination. Statistics: The study was started with null hypothesis. The statistical significance was measured with Chi-square test and two sample t test.Results:184 of the 200 patients (92%) knee synovium showed HP features of osteoarthritis. The discordant diagnoses and discrepant diagnosis rate was 8 % and 7 % respectively which is statistically significant by ChiConclusion:8% of our patients exhibited results which were totally unexpected. Our study showed a 7 % rate of discrepant diagnosis, which if missed would have affected the function and long term survival of the implanted TKR.