Does Patient Perception of Pain Influence How Patients Rate Their Experience after Total Knee Arthroplasty?

Press Ganey (PG) is an increasingly used measure to determine patient satisfaction. It has yet to be determined which factors influence the PG scores most amongst patients with inadequate pain control after total knee arthroplasty (TKA). Therefore, we assessed (1) which PG factors influence overall hospital rating (OHR) in patients who had poor pain control in comparison to those with good pain control and (2) whether pain control influences OHR during hospital admission following TKA. An institutional database search was performed between November 2009 and January 2015 for all TKA patient responders to the PG questionnaire. This yielded 148 patients (mean = 61 years; range, 24–92 years). Pain control was graded on a scale from 1(least satisfied) to 4 (most satisfied). Patients were separated into two cohorts: those who had poor pain control (score ≤ 2) and those who had good pain control (score > 2). Multiple regression analysis assessed the weighted means (β) of all PG categories on OHR. To compare the demographics and survey responses between the two cohorts, χ 2 and t-tests were utilized. For patients with poor pain control, the responsiveness of hospital support staff had the highest influence on OHR (β = 2.103), followed by communication about medications (β = 1.230). For patients with good pain control, communication with nurses had the strongest effect on hospital rating (β = 0.233, p = 0.056), followed by communication about medications (β = 0.200, p = 0.049). The patients with good pain control had significantly higher OHR (6.0 vs. 9.1, p = ≤ 0.001) and scores in each category of PG. Communication about medications and responsiveness of hospital staff had a significant effect on OHR. Well-controlled patients were highly influenced by communication of medication and communication with nurses. Moreover, patients with good pain control had significantly higher scores in all areas of PG survey, signifying that patient perception of pain affects patient satisfaction with the hospital. Orthopaedists should be involved in direct efforts to improve pain control as well as address the aforementioned PG domains.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

The Journal of Hip Surgery ◽

10.1055/s-0040-1712523 ◽

2020 ◽

Vol 04 (02) ◽

pp. 084-089

Author(s):

Vivek Singh ◽

Stephen Zak ◽

Ran Schwarzkopf ◽

Roy Davidovitch

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Demographic Data ◽

Demographic Differences ◽

Total Hip ◽

Forgotten Joint Score ◽

Total Knee

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p < 0.001), 12 months (66.00 vs. 43.57; p < 0.001), and 21 months (73.45 vs. 47.22; p < 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

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The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996632 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199663

Author(s):

Mustafa Kaçmaz ◽

Zeynep Yüksel Turhan

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Nerve Block ◽

Knee Arthroplasty ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Adductor Canal Block ◽

Adductor Canal ◽

Significant Difference ◽

Total Knee

Introduction: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not. Methods: A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB. Results: Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05). Discussion: When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction. Conclusion: We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

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Education, engagement and provision of empathy by trained counselor enhances the patient satisfaction after Total Knee Arthroplasty

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.03.011 ◽

2021 ◽

Author(s):

Sanjay Bhalchandra Londhe ◽

Ravi Vinod Shah ◽

Pritesh Omprakash Agrawal ◽

Jehangir Malcolm Pestonji ◽

Shubhankar Sanjay Londhe ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Total Knee ◽

Trained Counselor

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Adductor canal block versus periarticular infiltration for pain control following total knee arthroplasty

Medicine ◽

10.1097/md.0000000000019903 ◽

2020 ◽

Vol 99 (17) ◽

pp. e19903

Author(s):

Na Yuan ◽

Jun Shi ◽

Chunyan Lin ◽

Jiang Li

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Pain Control ◽

Adductor Canal Block ◽

Adductor Canal ◽

Total Knee ◽

Periarticular Infiltration

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Acceptable Functional Outcomes and Patient Satisfaction Following Total Knee Arthroplasty in Asians with Severe Knee Stiffness: A Matched Analysis

Clinics in Orthopedic Surgery ◽

10.4055/cios.2018.10.3.337 ◽

2018 ◽

Vol 10 (3) ◽

pp. 337 ◽

Cited By ~ 3

Author(s):

Bryce W Polascik ◽

Hamid Rahmatullah Bin Abd Razak ◽

Hwei-Chi Chong ◽

Ngai-Nung Lo ◽

Seng-Jin Yeo

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Functional Outcomes ◽

Knee Stiffness ◽

Total Knee

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Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2019-0636.r7 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1254-1260

Author(s):

Lorenzo Calabro ◽

Nick D. Clement ◽

Deborah MacDonald ◽

James T. Patton ◽

Colin R. Howie ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Venous Thromboembolism ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Significant Independent Predictor ◽

Total Knee ◽

Five Dimension ◽

One Year

Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. Results A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254–1260.

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Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty

The Surgery Journal ◽

10.1055/s-0037-1604010 ◽

2017 ◽

Vol 03 (03) ◽

pp. e110-e112

Author(s):

Benjamin Rossi ◽

Narlaka Jayasekera ◽

Fionnuala Kelly ◽

Keith Eyres

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Postoperative Recovery ◽

Patient Perception ◽

Femoral Bone ◽

Bone Resection ◽

Orthopaedic Literature ◽

Total Knee ◽

A Prospective Study ◽

Revision Tka

AbstractThe aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even ‘well-informed’ patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.

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