Revisiting patient satisfaction following total knee arthroplasty: a longitudinal observational study

BackgroundTotal knee arthroplasty (TKA) is the most common joint replacement surgery in Canada. Earlier Canadian work reported 1 in 5 TKA patients expressing dissatisfaction following surgery. A better understanding of satisfaction could guide program improvement. We investigated patient satisfaction post-TKA in British Columbia (BC).MethodsA cohort of 515 adult TKA patients was recruited from across BC. Survey data were collected preoperatively and at 6 and 12months, supplemented by administrative health data. The primary outcome measure was patient satisfaction with outcomes. Potential satisfaction drivers included demographics, patient-reported health, quality of life, social support, comorbidities, and insurance status. Multivariable growth modeling was used to predict satisfaction at 6months and change in satisfaction (6 to 12months).ResultsWe found dissatisfaction rates (very dissatisfied, dissatisfied or neutral) of 15% (6months) and 16% (12months). Across all health measures, improvements were seen post-surgery. The multivariable model suggests satisfaction at 6months is predicted by: pre-operative pain, mental health and physical health (odds ratios (ORs) 2.65, 3.25 and 3.16), and change in pain level, baseline to 6months (OR 2.31). Also, improvements in pain, mental health and physical health from 6 to 12months predicted improvements in satisfaction (ORs 1.24, 1.30 and 1.55).ConclusionsTKA is an effective intervention for many patients and most report high levels of satisfaction. However, if the TKA does not deliver improvements in pain and physical health, we see a less satisfied patient. In addition, dissatisfied TKA patients typically see limited improvements in mental health.