Patient Dissatisfaction Following Total Knee Arthroplasty (Systematic Review and Meta-Analysis)

Abstract

Background TKA is a very successful form of treatment for degenerative osteoarthiritis of the knee. The demand for TKA is growing around the world because of the aging population and the need to preserve people's quality of life. However, one in every 300 knee arthroplasties, pain without any known explanation will be present. The pain may occur either at rest or with movement. The knee may have a good range of motion, and objective evaluation of the prosthesis may show a perfect result, with good positioning of the implants seen on radiographs, yet the patient complains of pain. Adequate assessment of this condition is important for orthopedists who carry out TKA. Objective To identify the causes and predictors of patient`s dissatisfaction after complicated TKA (eg., component malalignment, post early/late infection, patellar tendon rupture, … etc), factors of residual pain during activities of daily living and/or at rest, relation of pain and function in determining dissatisfaction, improvement of TKA outcome measures. Patients and Methods The review included Randomized controlled trials (RCT) that studied patient dissatisfaction particularly related to pain following TKA. Also, we included cluster RCTs, controlled (non randomized) clinical trials, prospective comparative cohort studies, and case – control studies. Cross –sectional studies, case series, and case reports were excluded. Only studies on human subjects were included (studies on patients having TKA). Results 25 studies were included from 2009 to 2019; 24 were prospective studies and one prospective randomized control trial. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion There was a need to consider new interventions to promote mental health and wellness amongst patients receiving TKA but this should, of course, be subjected to evaluation of its costs and benefits before implementation. Further research is needed to quantitatively analyze the discontentment factors that emerged from this study.