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Patient satisfaction in TKR JBJS

Josephine

NURSE DIRECTOR EMERITUS
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Patient Satisfaction Following TKA: Bless Them All!
by David Beverland, MD, FRCS, Primary Joint Unit, Musgrave Park Hospital, Belfast, United Kingdom. Published September 2010

Survivorship following modern total knee arthroplasty (TKA) is good with revision rates generally lower than for total hip arthroplasty

As surgeons, we often think that the knee implant that we use is the best but at present, the implant is no longer the most critical factor.

For some time in Belfast, it had been our impression that although survivorship was excellent following TKA, the patients were not as happy as those undergoing total hip arthroplasty (THA). We put this hypothesis to the test by developing a simple 4-point score:
1. Very happy—patient will feel they have a “forgotten joint” that feels normal;
2. Happy;
3. OK but not perfect
4. Never happy - frequently worse than pre-operatively.​

The questionnaire was given to our cohort of 440 TKA patients at the time of their 10-year review. For comparison, we gave the same questionnaire at the same time to a cohort of 565 THA patients. When we looked at the answers to questions 1 and 4, very happy and never happy, the differences between the total knees and total hips were staggering.

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The full results

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There are 2 areas that are the most important. The first is patient education because this can alter patient expectation. The second is surgeon education, as many early failures are a result of surgical error.

One of the most important factors is patient education. We also need more understanding about what pre-operative factors influence satisfaction so we can try to modify their influence and better inform our patients. We need to continue to focus on surgeon education.
 

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