Patient Satisfaction After Total Knee Replacement: A Systematic Review

Abstract

Background: The quality and state of satisfaction reporting after total knee replacement (TKR) is variable.

Questions/purposes: The purposes of this systematic review were (1) to examine the available literature on patient satisfaction after TKR, (2) to evaluate the quality of available evidence, and (3) to identify predictors of patient satisfaction after TKR.

Methods: A systematic review of the MEDLINE database was performed. The initial search yielded 1219 studies. The inclusion criteria were English language, clinical outcome study with primary outcome related to TKR for osteoarthritis, and patient-reported satisfaction included as an outcome measure. Studies were assessed for demographics, methodology for reporting satisfaction, and factors influencing satisfaction.

Results: Two hundred eight studies, including 95,560 patients who had undergone TKR, met all inclusion and exclusion criteria; 112 (53.8%) of these studies were published in the past 3 years. Satisfaction was most commonly measured using an ordinal scale. Twenty-seven studies (13%) used a validated satisfaction survey. Eighty-three percent of studies reported more than 80% satisfaction. The most commonly reported predictor of satisfaction was post-operative patient-reported functional outcome. Pre-operative anxiety/depression was the most common pre-operative predictor of dissatisfaction.

Conclusion: There are numerous studies reporting patient satisfaction after TKR, and publication on the topic has been increasing over the past decade. However, the majority of studies represent lower levels of evidence and use heterogeneous methods for measuring satisfaction, and few studies use validated satisfaction instruments. In general, the majority of studies report satisfaction rates ranging from 80 to 100%, with post-operative functional outcome and relief of pain being paramount determinants for achieving satisfaction.

Keywords: PRISMA; patient satisfaction; systematic review; total knee arthroplasty.

Conflict of interest statement

Compliance with Ethical StandardsInvestigation was performed at the Hospital for Special Surgery. Cynthia A. Kahlenberg, MD, and Benedict U. Nwachukwu, MD, MBA, declare that they have no conflicts of interest. Alexander S. McLawhorn, MD, MBA, reports receiving personal fees from Intellijoint and from Johnson & Johnson, as well as holding board or committee membership with American Association of Hip and Knee Surgeons and editorial board membership with American Journal of Orthopedics and HSS Journal, outside the submitted work. Charles N. Cornell, MD, reports receiving personal fees from Clinical Orthopaedics and Related Research and from HSS Journal, as well as governing or editorial board membership with Clinical Orthopaedics and Related Research, HSS Journal, Journal of Bone and Joint Surgery, and Springer, outside the submitted work; he also recused himself from the peer review of this article. Michael B. Cross, MD, reports receiving personal fees from Acelity, Acelity Surgical Advisory Board, Exactech, Intellijoint, Journal of Orthopaedics and Traumatology, Link Orthopaedics, Smith & Nephew, Theravance Biopharma, and Zimmer, as well as holding editorial or governing board membership with Bone and Joint Journal 360, Techniques in Orthopaedics, and Journal of Orthopaedics and Traumatology, outside the submitted work. Douglas E. Padgett, MD, reports receiving personal fees from DJ Orthopedics and from PixarBio and holding board or committee membership with the American Joint Replacement Registry, the Journal of Arthroplasty, and the Hip Society, outside the submitted work.All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.N/A.Disclosure forms provided by the authors are available with the online version of this article.

Figures

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart illustration of study inclusion and exclusion criteria

Fig. 2

Number of publications by region

Fig. 3

Trend in publication number over time

Fig. 4

Percentage of patients classified as “satisfied” by each individual study; in general, most studies considered patients “satisfied” if they scored 4 or 5 (satisfied or very satisfied) on a 5-point ordinal scale or ≥ 7 on a 10-point scale