Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?

Suzanne Witjes,Koen L M Koenraadt,P Paul F M Kuijer,Leendert Blankevoort,Rutger C I Van Geenen,Cor P Van Der Hart,Gino M M J Kerkhoffs

doi:10.1007/s11136-016-1380-9

Abstract

PurposeIndications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance.MethodsFocus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated.ResultsData saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important.ConclusionYounger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.

Highlights

Both total knee arthroplasty (TKA) and uniconcylar knee arthroplasty (UKA) are performed at younger ages than before [1,2,3,4] since they are well-accepted, reliable, costeffective and suitable surgical procedures for end-stage knee osteoarthritis (OA) [5, 6]
Focus groups were performed among osteoarthritis (OA) patients \65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA
Meeting patient expectations is of utmost importance to satisfy patients after KA

Summary

Introduction

Both total knee arthroplasty (TKA) and uniconcylar knee arthroplasty (UKA) are performed at younger ages than before [1,2,3,4] since they are well-accepted, reliable, costeffective and suitable surgical procedures for end-stage knee osteoarthritis (OA) [5, 6]. Arthroplasty surgery was originally conceived for elderly patients performing activities at low levels. In these early days younger age was even a strict contraindication [7]. The volume of TKA-surgeries has increased worldwide, like in the USA up to 200 % over the past decade. According to the last annual report of the Dutch Arthroplasty Register (LROI), in The Netherlands, the number of registered KAs has increased (from 20,558 in 2010 to 26,754 in 2014). In 2014, already 23 % of KAs were performed in patients younger than 60 years old (http://www.lroi.nl/en/home)

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