Abstract
BackgroundJoint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). Findings from qualitative and psychometric studies suggest that joint awareness is a distinct concept especially relevant to patients with good surgical outcome and patients at late follow-up time points. The aim of this study was to improve the understanding of the concept of joint awareness by identifying situations in which patients are aware of their artificial knee joint and to investigate what bodily sensations and psychological factors raise a patient’s awareness of her/his knee. In addition, we evaluated the relative importance of patient-reported outcome parameters that are commonly assessed in orthopaedics.MethodsQualitative interviews were conducted with patients being at least 12 months after TKA. The interviews focused on when, where and for what reasons patients were aware of their artificial knee joint. To evaluate the relative importance of ‘joint awareness’ after TKA among nine commonly assessed outcome parameters (e.g. pain or stiffness), we collected importance ratings (‘0’ indicating no importance at all and ‘10’ indicating high importance).ResultsWe conducted interviews with 40 TKA patients (mean age 69.0 years; 65.0% female). Joint awareness was found to be frequently triggered by kneeling on the floor (30%), climbing stairs (25%), and starting up after resting (25%). Patients reported joint awareness to be related to activities of daily living (68%), specific movements (60%), or meteoropathy (18%). Sensations causing joint awareness included pain (45%) or stiffness (15%). Psychological factors raising a patient’s awareness of his/her knee comprised for example feelings of insecurity (15%), and fears related to revision surgeries, inflammations or recurring pain (8%). Patients’ importance ratings of outcome parameters were generally high and did not allow differentiating clearly among them.ConclusionsWe have identified a wide range of situations, activities, movements and psychological factors contributing to patients’ awareness of their artificial knee joints. This improves the understanding of the concept of joint awareness and of a patient’s perception of his/her artificial knee joint. The diversity of sensations and factors raising patient’s awareness of their joint encourages taking a broader perspective on outcome after TKA.
Highlights
Joint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA)
Joint arthroplasty surgery has proven to be successful in relieving pain and improving function in patients with osteoarthritis [1,2,3]
Sample and procedure Patients were consecutively approached for the study if they had had a TKA at the Medical University of Innsbruck and were at least 12 months after surgery
Summary
Joint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). As joint arthroplasty has evolved and outcome has improved considerably in the last decades, commonly applied PRO tools show relevant ceiling effects at follow-up [11,12,13,14,15,16] This means that these tools (e.g. Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index [17], Oxford Hip Score [18, 19]) have difficulties in discriminating between patients with good outcome and patients with very good and excellent outcome. To overcome this problem joint awareness was established as a new, more discerning construct for outcome assessment in orthopaedics. Hudak et al showed that in patients undergoing hand surgery the unity of the hand and the patient’s self is strongly related to patient satisfaction and the authors concluded ‘satisfaction was having a hand that could be lived with unself-consciously’ ([21] p718)
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