scholarly journals Preoperative and intraoperative factors contributing to patient satisfaction after bi-cruciate stabilized total knee arthroplasty

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110340
Author(s):  
Hiroshi Inui ◽  
Shuji Taketomi ◽  
Ryota Yamagami ◽  
Kenichi Kono ◽  
Kohei Kawaguchi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Regression Analysis ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Joint Laxity ◽  
Satisfaction Score ◽  
Patient Reported ◽  
Total Knee

Background: One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify preoperative and intraoperative predictors of patient satisfaction after BCS TKA. Methods: Altogether, we studied 113 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system. Preoperative parameters including Knee Society Score and patient-reported scores [the Knee injury and Osteoarthritis Outcome Score (KOOS)] and intraoperative parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age and preoperative and intraoperative parameters that correlated with satisfaction scores in the univariate analysis ( P < 0.05). Results: The mean satisfaction score was 28.2 ± 6.1. Multivariate regression analysis showed that the predictors of patient satisfaction were a preoperative high KOOS score for activities of daily living ( P < 0.001), male sex ( P = 0.005), older age ( P = 0.027), and minimal medial joint laxity during flexion ( P = 0.031). Conclusion: When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment, especially during flexion.

scholarly journals Influence of surgical factors on patient satisfaction after bi‐cruciate stabilized total knee arthroplasty: retrospective examination using multiple regression analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroshi Inui ◽  
Shuji Taketomi ◽  
Ryota Yamagami ◽  
Kenichi Kono ◽  
Kohei Kawaguchi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Regression Analysis ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Univariate Analysis ◽  
Joint Laxity ◽  
Satisfaction Score ◽  
Patient Satisfaction Score ◽  
Total Knee

Abstract Background One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify intraoperative surgical predictors of patient satisfaction after BCS TKA. Methods We studied 104 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system retrospectively. Surgical parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age, gender, body mass index and intraoperative parameters that correlated with satisfaction scores in the univariate analysis (P < 0.05). The current study focused on the patient satisfaction score at 1 year postoperatively and didn’t evaluate the long term clinical results nor survivorship. Results The postoperative satisfaction score was 28.6 ± 8.1. Multivariate analysis showed that medial joint laxity at 30° flexion (P = 0.003), tibial excessive external rotation alignment (P = 0,009) and tibial varus alignment (P = 0.029) were predictors of poor satisfaction score. Conclusions When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment at mid flexion range and should avoid tibial varus and excessive external rotational alignment.

Patient-Reported Functional and Satisfaction Outcomes after Robotic-Arm-Assisted Total Knee Arthroplasty: Early Results of a Prospective Multicenter Investigation

2019 ◽  
Vol 33 (07) ◽  
pp. 685-690 ◽  
Author(s):  
Anton Khlopas ◽  
Nipun Sodhi ◽  
William J. Hozack ◽  
Antonia F. Chen ◽  
Ormonde M. Mahoney ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Scoring System ◽  
Satisfaction Score ◽  
Robotic Arm ◽  
Open Label ◽  
Functional Activities ◽  
Early Results ◽  
Patient Reported ◽  
Total Knee

The purpose of this study was to perform a 3-month interim comparative analysis on outcomes between robotic-arm-assisted total knee arthroplasty (RATKA) and manual TKA patients. Specifically, we evaluated (1) patient self-reported symptoms, (2) expectations and satisfaction, and (3) functional activities, based on the 2011 Knee Society Scoring System. Between June 1, 2016, and March 31, 2018, 252 patients (102 manual and 150 robotic) were enrolled into a prospective, nonrandomized, open-label, multicenter comparative cohort study. Functional activity scores, patient-reported symptoms, as well as satisfaction and expectation scores were obtained from the 2011 Knee Society Scoring System preoperatively, at 4 to 6 weeks, and at 3 months postoperatively. Student's t-tests, Wilcoxon rank-sum tests, and chi-square tests with α set at 0.05 were used to compare between-group mean improvements from baseline. At 4 to 6 weeks postoperatively, RATKA patients were found to have significantly larger improvements in walking and standing (1.4 vs. –1.2 points; p = 0.019). RATKA patients were also found to have larger improvements in advanced activities (1.3 vs. 2.3 points), pain with walking (3.3 vs. 3.2 points), satisfaction score (12.4 vs. 12 points), and expectations score (5.1 vs. 4.4 points) when compared with manual TKA patients. At 3 months, RATKA patients were also found to have larger improvements in walking and standing (6.0 vs. 4.8 points), standard activities (11.4 vs. 10.1 points), advanced activities (6.2 vs. 4.6 points), functional activities total score (22.8 vs. 21.2 points), pain with walking (4.3 vs. 4.1 points), total symptoms score (10.5 vs. 10.3 points), satisfaction score (17.0 vs. 15.5 points), expectations score (4.8 vs. 4.0 points) when compared with manual TKA patients. The data indicate RATKA patients to have equal or greater improvements in 9 out of 10 of the Knee Society Scoring System components assessed at 3 months postoperatively, though not all findings were statistically significant. Since this is an early results report, this study will be continued for a longer follow-up, but we are encouraged by these interim results.

The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question

2018 ◽  
Vol 100-B (6) ◽  
pp. 740-748 ◽  
Author(s):  
N. D. Clement ◽  
M. Bardgett ◽  
D. Weir ◽  
J. Holland ◽  
C. Gerrand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Patient Satisfaction ◽  
Back Pain ◽  
Pain Relief ◽  
Logistic Regression Analysis ◽  
Knee Arthroplasty ◽  
Total Knee ◽  
One Year

AimsThe primary aim of this study was to assess the rate of patient satisfaction one year after total knee arthroplasty (TKA) according to the focus of the question asked. The secondary aims were to identify independent predictors of patient satisfaction according to the focus of the question.Patients and MethodsA retrospective cohort of 2521 patients undergoing a primary unilateral TKA were identified from an established regional arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 12-Item Short-Form Health Survey (SF-12) scores were collected preoperatively and one year postoperatively. Patient satisfaction was assessed using four questions, which focused on overall outcome, activity, work, and pain. Logistic regression analysis was used to identify independent preoperative predictors of increased stiffness when adjusting for confounding variables.ResultsUsing patient satisfaction with the overall outcome (n = 2265, 89.8%) as the standard, there was no difference in the rate of satisfaction for pain relief (n = 2277, odds ratio (OR) 0.95, 95% confident intervals (CI) 0.79 to 1.14, p = 0.60), but patients were more likely to be dissatisfied with activities (79.3%, n = 2000/2521, OR 2.22, 95% CI 1.96 to 2.70, p < 0.001) and work (85.8%, n = 2163/2521, OR 1.47, 95% CI 1.23 to 1.75, p < 0.001). Logistic regression analysis identified different predictors of satisfaction for each of the focused satisfaction questions. Overall satisfaction was influenced by diabetes (p = 0.03), depression (p = 0.004), back pain (p < 0.001), and SF-12 physical (p = 0.008) and mental (p = 0.01) components. Satisfaction with activities was influenced by depression (p = 0.001), back pain (p < 0.001), WOMAC stiffness score (p = 0.03), and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with work was influenced by depression (p = 0.007), back pain (p < 0.001), WOMAC function (p = 0.04) and stiffness (p = 0.05) scores, and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with pain relief was influenced by diabetes (p < 0.001), back pain (p < 0.001), and SF-12 mental component (p = 0.04).ConclusionThe focus of the satisfaction question significantly influences the rate and the predictors of patient satisfaction after TKA. Cite this article: Bone Joint J 2018;100-B:740–8.

Primary Total Knee Arthroplasty: Correlation between Preoperative Radiographic Severity of Arthritis and Postoperative Patient Satisfaction

2020 ◽  
Author(s):  
Katie Rooks ◽  
Devon Houdek ◽  
Haron Obaid ◽  
William Dust
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Retrospective Chart Review ◽  
Level Of Evidence ◽  
Radiographic Severity ◽  
Patient Reported ◽  
Degree Of Satisfaction ◽  
Total Knee

AbstractPredicting postoperative outcomes following total knee arthroplasty (TKA) is important for patient selection. This study focuses on patient-reported outcomes and satisfaction in relation to preoperative radiographic arthritis severity. A retrospective chart review of 420 TKAs was performed. Patient satisfaction was determined using a structured telephone survey with questions focused on degree of satisfaction whether they would have surgery again and their ability to kneel. The radiographic severity of the arthritis of the tibiofemoral joint was graded by a musculoskeletal radiologist using the Kellgren–Lawrence grading scale. The patellofemoral compartment was graded using the scale described by Jones et al. Those grouped as severe arthritis had an overall satisfaction rate of 96% (76% fully satisfied and 20% partially satisfied) compared with 82% of the time (64% fully satisfied and 18% partially satisfied) if their arthritis was mild. Postoperatively 51% of TKA patients were able to kneel. Univariate logistic regression showed an association between higher rates of satisfaction and male gender (p = 0.053), severity of preoperative radiographic arthritis (p = 0.034) those who would have surgery again (p ≤ 0.0001) and those able to kneel (p = 0.005). Patients should be informed preoperatively that if their arthritis is only mild radiographically, their outcomes are less predictable. There should also be a discussion surrounding kneeling and activities patients do, which may require kneeling, as many are unable to kneel postoperatively. The Level of Evidence for the study is III.

Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty

2018 ◽  
Vol 138 (8) ◽  
pp. 1143-1150 ◽  
Author(s):  
Masayuki Azukizawa ◽  
Shinichi Kuriyama ◽  
Shinichiro Nakamura ◽  
Kohei Nishitani ◽  
Stephen Lyman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Joint Laxity ◽  
Total Knee

The influence of compressive forces across the patellofemoral joint on patient-reported outcome after bi-cruciate stabilized total knee arthroplasty

2018 ◽  
Vol 100-B (12) ◽  
pp. 1585-1591 ◽  
Author(s):  
T. Kaneko ◽  
N. Kono ◽  
Y. Mochizuki ◽  
M. Hada ◽  
T. Sunakawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Compressive Force ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Total Knee ◽  
The Relationship ◽  
Anterior Knee

Aims Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome. Patients and Methods This prospective study included 42 patients (42 knees) with varus-type osteoarthritis who underwent a bi-cruciate stabilized total knee arthroplasty and in whom the planned alignment was confirmed on 3D CT. Of the 42 patients, 36 were women and six were men. Their mean age was 72.3 years (61 to 87) and their mean body mass index (BMI) was 24.4 kg/m 2 (18.2 to 34.3). After implantation of the femoral and tibial components, the compressive force across the patellofemoral joint was measured at 10°, 30°, 60°, 90°, 120°, and 140° of flexion using a load cell (Kyowa Electronic Instruments Co., Ltd., Tokyo, Japan) manufactured in the same shape as the patellar implant. Multiple regression analyses were conducted to investigate the relationship between intraoperative patellofemoral compressive force and patient-reported outcome two years after implantation. Results No patient had anterior knee pain after total knee arthroplasty. The compressive force across the patellofemoral joint at 140°of flexion was negatively correlated with patient satisfaction (R 2 = 0.458; β = –0.706; p = 0. 041) and Forgotten Joint Score-12 (FJS-12; R 2 = .378; β = –0.636; p = 0. 036). The compressive force across the patellofemoral joint at 60° of flexion was negatively correlated with the patella score (R 2 = 0.417; β = –0.688; p = 0. 046). Conclusion Patient satisfaction, FJS-12, and patella score were affected by the patellofemoral compressive force at 60° and 140° of flexion. Reduction of the patellofemoral compressive forces at 60° and 140° of flexion angle during total knee arthroplasty may improve patient-reported outcome, but has no effect on anterior knee pain.

scholarly journals Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius

2020 ◽  
Vol 102-B (11) ◽  
pp. 1542-1548
Author(s):  
Paul H. C. Stirling ◽  
William M. Oliver ◽  
Huai Ling Tan ◽  
Iain D. M. Brown ◽  
Christopher W. Oliver ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Patient Satisfaction ◽  
Distal Radius ◽  
Multivariate Regression ◽  
Corrective Osteotomy ◽  
Multivariate Regression Analysis ◽  
Ulnar Styloid ◽  
Ulnar Styloid Fracture ◽  
Patient Reported

Aims The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. Methods We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. Results Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). Conclusion We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542–1548.

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

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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