Total knee arthroplasty is one of the most common and rewarding procedures in orthopaedic surgery. However, it remains for many people a costly procedure, and one in five patients remains dissatisfied with their prosthesis.
The aim of this work was to calculate the satisfaction rate after total knee arthroplasty and to establish predicting patient satisfaction factors in low-income population.
Our study included 279 primary total knee arthroplasties placed between 2015 and 2019 with a minimum follow-up of two years. Our retrospective census took into account the various factors concerning the patient’s background and monthly family income, the surgical procedure and the knee-related parameters before and after surgery. Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee (IKDC) subjective scores. Satisfaction was estimated by a yes or no question.
The mean age of patients was 68 years-old. Over 95% declared < 1000 US$ monthly family income. At the last follow-up, all our patients reported a functional improvement with better WOMAC and IKDC scores. The overall dissatisfaction rate was 22.6%. Two parameters concerning the patient’s background had a statistically significant link with dissatisfaction: the female sex and the history of diabetes. Only one parameter related to the knee preoperatively had a direct, statistically significant influence on increasing dissatisfaction risk: limited range of motion with flexion <90°. No parameters related to surgery had a statistically significant link with satisfaction. Regarding parameters related to the knee after surgery, only moderate to severe residual pain (Visual Analog Scale: VAS>3) was associated with patient dissatisfaction after total knee replacement.
Recognition of factors predicting patient satisfaction after total knee arthroplasty should influence our behaviour so as to act on the modifiable factors, allowing to reduce the risk of dissatisfaction to minimum, or to have a more alert attitude towards non modifiable factors in order to adapt the therapeutic care and to better inform and educate patients.