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Patient-Perceived Dissatisfaction Following a Total Knee Replacement Might Be Higher Than You Think

by Greg Hirsch

Total Knee Replacement (TKR) surgery continues to be an effective method for alleviating or eliminating joint pain for the majority of recipients. However, there still tends to be a considerable percentage of patients reporting residual symptoms within 5 years of their operation. A national, multi-centre study was conducted looking at the degree of patient satisfaction, incidence of residual symptoms, and how many patients claimed their knee to feel ‘normal’. The study looked at patients identifying as both male and female, as well as patients of low-income households to see if these socioeconomic factors had any impact on patient-perceived satisfaction following a TKR. 

What the study found is that a total of 90% surveyed reported satisfaction with the overall functioning of their knee with 89% satisfied with their ability to perform activities of daily living. It should be noted that these percentages are when patients are between 1 and 4.7 years following the procedure with the average being 2.6 years.This amount of time is generally well after most surgeons describe the period to complete recovery. So, with 90% and 89% of patients reporting overall satisfaction, this would seem quite high and encouraging, however, the percentage drops quite a bit when asking patients if they would describe their knee replacement as feeling ‘normal’.  Only 66% of patients made this claim. Furthermore, the percentage of patients reporting lingering symptoms such as: pain, stiffness, grinding, popping, swelling, tightness, difficulty getting in or out of a car or chair, and difficulty with stairs ranged from 33% to 54%. A third to just over half of patients are still experiencing complications related to their joint replacement. The study also points out patients identifying as female, as well as patients from low income households reported even higher degrees of dissatisfaction. 

There were a couple different variables with how the procedure was performed, mostly centering around whether or not the use of custom cutting guides (CCG) were used during the surgery and if they were used to perform mechanically aligned TKR or kinematically aligned TKR. (If you’d like to read more on the differences between mechanical alignment and kinematic alignment, we have talked more about that in a previous blog post found HERE). The study ultimately found that the use of CCG when performing a mechanically aligned TKR did not have significant statistical differences in patient perceived outcomes. The one major difference researchers found is that the use of CCG during a kinematic aligned TKR resulted in patients being THREE TIMES MORE LIKELY to say their knee felt ‘normal’. 

While this study presents some eye-opening data regarding the margin for improvement when it comes to total knee replacements, it also highlights the potential for personalized knee replacement techniques. To learn more about the Kinomatic approach to custom surgical procedures, check out our other posts HERE or visit our website

To read the original study in full, follow the link below:

Authors: D. Nam, R. M. Nunley, R. L. Barrack

https://doi.org/10.1302/0301-620X.96B11.34152

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