Patient dissatisfaction after total knee arthroplasty for advanced painful osteoarthritis of the knee

Abstract

BACKGROUND: In advanced painful osteoarthritis of the knee (APOAK) the last resort is total knee arthroplasty (TKA). However, some patients with APOAK are not satisfied despite a good clinical result. PURPOSE: The purpose of this article is to review the literature on APOAK with the aim of clarifying what is the rate of dissatisfaction after TKA and its main causes. METHODS: A review the literature on APOAK was performed to know their rates of dissatisfaction after TKA and their main causes. The search engines were MedLine and the Cochrane Library. The keywords used were: “TKA patient satisfaction”. Three hundred and seventy-four articles were found in MedLine on osteoarthritis. Of those, only 10 were selected and reviewed because they were strictly focused on the topic of this article (this was the basis for rejection or acceptance of articles). The second search engine was the Cochrane Library, where only four randomized clinical trials (RCTs) were found on osteoarthritis. Overall, 14 papers have been analyzed. RESULTS: In APOAK the rate of dissatisfaction ranges between 8% and 19% (12% on average). Causes of dissatisfaction in APOAK are high preoperative body mass index (BMI), lack of fulfillment of patient expectations, a low 1-year WOMAC (Western Ontario and McMaster University Arthritis Index), preoperative pain at rest, a postoperative complication requiring hospital readmission, a poor preoperative psychological state, and African American population. The use of femoral/sciatic analgesia and therapy dogs has shown to increase the degree of satisfaction. CONCLUSION: In APOAK the rate of dissatisfaction ranges between 8% and 19% (12% on average). Causes of dissatisfaction in APOAK are high preoperative BMI, lack of fulfillment of patient expectations, a low 1-year WOMAC, preoperative pain at rest, a postoperative complication requiring hospital readmission, a poor preoperative psychological state, and African American population. The use of femoral/sciatic analgesia and therapy dogs has shown to increase the degree of satisfaction. It is important to emphasize that some causes of dissatisfaction cannot be easily avoided or changed.