ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #907

 

What Factors Predict Patient Dissatisfaction After Contemporary Revision Total Knee Arthroplasty?

Keun-Young Choi, MD, Seoul KOREA, REPUBLIC OF
Man-Soo Kim, MD, Seoul KOREA, REPUBLIC OF
Yong In, MD, PhD, Seoul KOREA, REPUBLIC OF

The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, KOREA, REPUBLIC OF

FDA Status Cleared

Summary

Central sensitization and metaphyseal cementing only technique of tibial stem were strongly associated with patient dissatisfaction following revision TKA.

Abstract

Introduction

The patient satisfaction of primary total knee arthroplasty (TKA) was reported greater than 80%. On the other hand, the rates of satisfaction after revision TKA was lower than primary TKA. While the predictors of dissatisfaction after TKA have been widely studied, there is limited knowledge regarding the factors associated with dissatisfaction following revision TKA. The purposes of this study were (1) to identify risk factors for dissatisfaction following revision TKA; and (2) to determine how these factors are affecting patient reported outcome measures (PROMs).

Methods

Between March, 2012 and June, 2016, 74 revision TKAs were performed by a single surgeon. Of these patients, 68 patients were included in this study and 6 patients were excluded due to follow-up loss of minimum 2 years. Preoperative demographics, presence or absence of a central sensitization, the cause of revision, prosthesis type, the use of stem or block, the cementing technique for the stem were recorded. Postoperative radiographs, including alignment, the degree of joint line, posterior condylar offset and Insall-Salvati ratio for patella height, postoperative range of motion, and PROMs including Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC), and patient satisfaction were evaluated. Patients were categorized into satisfied or dissatisfied group using satisfaction score of New Knee Society Scoring System (= 20 or < 20). Patient factors, surgical factors, and PROMs were compared by the identified predictors.

Results

Of the 68 patients, Forty eight (70.5%) patients were satisfied and twenty (29.5%) patients were dissatisfied with the outcome of their revision operation at postoperative 2 years. Multivariate logistic regression analysis showed that the odds of dissatisfaction following revision TKA were increased 20.412 times in patients with Central Sensitization Inventory score > 40 (95% CI; 3.656 – 113.957, P = 0.001) and 10.233 times in patients with hybrid cementing technique (metaphyseal cementing only) for tibial stem fixation compared to modified hybrid cementing technique (metaphyseal cementing + stem tip cementing) (95% CI; 1.011 - 103.558, P = 0.049).

Conclusion

Central sensitization and metaphyseal cementing only technique of tibial stem were strongly associated with patient dissatisfaction following revision TKA.