“Patients who are older, who have unrealistic expectations, who have comorbidities, who live alone, or who have a complication requiring hospital readmission are most likely to be dissatisfied following total knee replacement (TKR),” according to Robert B. Bourne, MD. Dr. Bourne presented the results of his paper, “Patient satisfaction after TKR: Who is happy and who is not?” at the 2009 AAOS Annual Meeting.

A low preoperative score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is also a factor, but a low WOMAC change score is even more predictive of patient satisfaction.

“Patients who will not achieve a WOMAC change score of more than 25 out of 100 points should be operated on with caution,” Dr. Bourne warned.

Identifying predictive factors
Several studies have shown that only 82 percent to 89 percent of patients are satisfied with their TKR.

To determine if certain factors might predict satisfaction or dissatisfaction, the researchers prospectively assessed 2,513 primary TKR patients in the Ontario Joint Replacement Registry. The mean age of patients was 69, and 60 per­cent of patients were female.

Demographic and clinical data, including a preoperative WOMAC questionnaire, were collected at the decision date for surgery. A year later, patients were mailed questionnaires asking if they would be willing to undergo surgery again (yes/no/uncertain), whether they had had postoperative complications requiring admission to a hospital overnight (yes/no/reason), and if their expectations had been met (met/not met/had none). The packet also contained the WOMAC questionnaire and a satisfaction questionnaire.

A total of 1,703 patients com­pleted the 1-year questionnaires.

Four in five are “satisfied” Only 81 percent of respondents reported being “satisfied;” just 70 percent felt their “expectations were met.” Nearly 9 out of 10 “would willingly undergo surgery again.”

The preoperative variables most often associated with dissatisfied patients included increasing age, living alone, knee flexion less than 90°, and extreme pain while sitting or lying.

Postoperative factors frequently associated with dissatisfied patients included lower 1-year WOMAC scores and change totals, unwillingness to have surgery again, expectations that had not been met, and complications requiring hospital admission.

“Hopefully, our findings will encourage orthopaedic surgeons to identify patients at risk and to discuss expectations to ensure that they are realistic,” Dr. Bourne said.

Dr. Bourne’s co-authors include Bert M. Chesworth, PhD; and Aileen M. Davis, PhD, who report no conflicts. Dr. Bourne’s disclosures Smith & Nephew, Johnson & Johnson, Stryker, and Zimmer.