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20/10/2007 PAIN INFLUENCES PATIENT SATISFACTION WITH TOTAL KNEE REPLACEMENT
You may think that it is a common sense: patient who continues to have pain in his / her total knee is dissatisfied with the operation result. Yet, this is just the conclusion of a study published by British surgeons (Baker 2007). There is moreover a good reason why this study was conducted and published. Most published results of total knee replacement present the percentage of failed total knees, the percentage of patients who needed revision operation of their total knee for whichever reason. So we will know from these studies how many total knees failed and needed a new operation. But we usually will not know how many patients with their total knees still in place were also satisfied with their total knee joint. And in many published studies it is the surgeon who assess the result and interrogates the patient. Such studies are biased. The British surgeons sent a questionnaire to 10 000 patients who were operated on one year ago with total knee replacement asking about their satisfaction with the new total knee joint. Then they combined patient’s answer with data about the pain, range of motion, and function in patient's new knee. The results are interesting and in some way chocking. Actually only 82% of patients were satisfied more or less with their total knee performance one year after surgery. And only 8.6% of all patients reported “no or hardly any problems” with their new knee! The unsatisfied patients have more often pain and less often bad function of their total knee as reason for dissatisfaction. Continuing severe pain troubled 20% of all patients, and pain on walking 17%! But even satisfied patients had many complaints about their total knees, such as: difficult kneeling (57% of all patients), pain on starting of walk (78%), difficulties in washing and drying themselves (83%), and limp (80%). Aged patients (>70 years) were more often satisfied than the younger patients (<65 years). The authors also say that satisfaction was influenced by the choice of certain total knee models but give no details. Obviously this question is too delicate because it concerns individual manufacturers and may possibly influence their economical commitment to the future research. A strange finding of this study is that “the grade of the lead surgeon” did not influence the satisfaction. Perhaps because even when the less experienced surgeon carried out the surgery, there was always a well experienced surgeon besides him to direct him, as is usual in hospitals educating new surgeons. Information for you: This study is very important. First, it shows the results of total knee replacement for a large patient group, not for a few carefully selected. Second, It says that even if the operation result of your total knee surgery will be good (satisfying for you and excellent for your surgeon) expect a lot of smaller difficulties, such as occasional pain and limp. Especially if you are relatively young. You should discuss very carefully the expected results of your total knee replacement with your surgeon and modify your expectations (if they are too great) with the view to the results presented in this study. And one more important point: In this study 8% of all patients had already any kind of new operation done within one year after surgery and 18% were expecting new surgery! ________________________________________
P. N. Baker et al.: The role of pain and function in determining patient satisfaction after total knee replacement. DATA FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND AND WALES. Journal of Bone and Joint Surgery - British Volume, 2007-Br; Vol 89-B, 893-900.
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