Analysis of dissatisfaction factors in patients underwent total knee arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2021.03.005

Abstract

Abstract:

Objective

To analyze the related factors of patients′ dissatisfaction after total knee arthroplasty(TKA).

Methods

The patients who underwent TKA from January 2012 to December 2015 were followed up by telephone, outpatient clinic and video call, including the patients who suffered from osteoarthritis, rheumatoid arthritis, traumatic arthritis and no serious postoperative complications. The patients of revison surgery were exclued.A total of 537 patients were enrolled, they were divided into the satisfied group and the dissatisfied group according to the subjective satisfaction score. The single factor and multivariate logistic regressions were used to analyze the influencing factors(including age, regular knee scores and postoperative discomfort) of dissatisfaction in the patients with TKA.

Results

Multivariate logistic regression analysis showed that more than 70 years old, higher Western Ontario and McMaster Universities(WOMAC)osteoarthritis score (OR=13.128) and postoperative discomfort (OR=19.275) increased patient dissatisfaction after TKA, and higher Hospital for Special Surgery (HSS)score reduced dissatisfaction of the patients after TKA(OR=0.141).

Conclusions

The patients over 70 years old are prone to produce dissatisfaction. Reducing postoperative discomfort is still an important factor to control dissatisfaction.

Key words: Arthroplasty, replacement, knee, Patient satisfaction, Risk factors

Cong Wang, Yuqi Liang, Guorong Zhang, Ning Ma, Ningqiang Liu, Tong Xie, Chongjun Guo, Dongsheng Niu. Analysis of dissatisfaction factors in patients underwent total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(03): 289-293.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2021.03.005

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2021/V15/I03/289

Figures/Tables 2

References 29

[1]	Zhang Y, JM Jordan. Epidemiology of osteoarthritis.[J]. Clinics in geriatric medicine, 2010, 26(3): 355-369.
[2]	王波，余楠生. 膝骨关节炎阶梯治疗专家共识(2018年版)[J/CD]. 中华关节外科杂志(电子版), 2019, 13(1): 124-130.
[3]	Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U．S., 2014 to 2030 [J]. J Bone Joint Surg Am, 2018, 100(17): 1455-1460.
[4]	杨礼庆，马超，杜帅. 人工全膝关节置换术围手术期疼痛管理现状[J]. 中国矫形外科杂志，2017, 25(3): 247-250.
[5]	Jenkins PJ, Clement ND, Hamilton DF, et al. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis.[J]. Bone Joint J, 2013, (1): 115-121.
[6]	Schulze A, Scharf HP. Satisfaction after total knee arthroplasty. Comparison of 1990-1999 with 2000-2012 [J]. Der Orthopade, 2013, 42(10): 858-865.
[7]	Scott CE, Howie CR, MacDonald D, et al. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients [J]. Bone Joint Surg Br, 2010, 92(9): 1253-1258.
[8]	Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not？[J]. Clin Orthop Relat Res, 2010, 468(1): 57-63.
[9]	Dunbar MJ, Richardson G, Robertsson O. I can′t get no satisfaction after my total knee replacement: rhymes and reasons [J]. Bone Joint J, 2013, 148-152.
[10]	Scott CE, Oliver WM, MacDonald D, et al. Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age [J]. Bone Joint J, 2016, (12): 1625-1634.
[11]	Keudell AV, Sodha S, Collins J, et al. Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis [J]. Knee, 2014, 21(1): 180-184.
[12]	Noble PC, Conditt MA, Cook KF, et al. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty [J]. Clin Orthop Relat Res, 2006, 45235-45243.
[13]	Townsend LA, Roubion RC, Bourgeois DM, et al. Impact of age on patient-reported outcome measures in total knee arthroplasty [J]. J Knee Surg, 2018, 31(6): 580-584.
[14]	Woon CY, Piponov H, Schwartz BE, et al. Total knee arthroplasty in obesity: in-hospital outcomes and national trends[J]. J Arthroplasty. 2016, 31(11): 2408-2414.
[15]	Martinez-Carranza N, Pettas A, Razzaz D, et al. Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2019, 105(6): 1067-1071.
[16]	Barrack RL, Ruh EL, Chen J, et al. Impact of socioeconomic factors on outcome of total knee arthroplasty [J]. Clin Orthop Relat Res, 2014, 472(1): 86-97.
[17]	刘桂梅，陈向梅. 老年心血管病合并焦虑抑郁症患者心律失常的动态心电图分析[J]. 中国现代药物应用，2018, 12(8)：11-12.
[18]	Pérez-Prieto D, Gil-González S, Pelfort X, et al. Influence of depression on total knee arthroplasty outcomes [J]. J Arthroplasty, 2014, 29(1): 44-47.
[19]	周红，崔新会. 膝关节损伤术后早期康复训练对其恢复的促进作用[J]. 海南医学，2020, 31(1): 92-95.
[20]	李东文. 髋膝关节置换术后患者家庭康复现状及对策研究[D]. 第二军医大学，2008.
[21]	翟振武，陈佳鞠，李龙. 2015～2100年中国人口与老龄化变动趋势[J]. 人口研究，2017, 41(4): 60-71.
[22]	Messier SP, Gutekunst DJ, Davis C, et al. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis [J]. Arthritis Rheum, 2005, 52(7): 2026-2032.
[23]	Tang X, Wang S, Zhan S, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China Health and Retirement Longitudinal Study [J]. Arthritis Rheum, 2016, 68(3): 648-653.
[24]	Dhurve K, Scholes C, El-Tawil S, et al. Multifactorial analysis of dissatisfaction after primary total knee replacement[J]. Knee. 2017, 24(4): 856-862.
[25]	Husain A, Lee GC. Establishing realistic patient expectations following total knee arthroplasty[J]. J Am Acad Orthop Surg, 2015, 23(12): 707-713.
[26]	Ghomrawi HMK, Lee LY, Nwachukwu BU, et al. Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study.[J]. J Am Acod Orthop Surg, 2020, 28(4): e145-e150.
[27]	Eymard F, Charles-Nelson A, Katsahian S, et al. "Forgotten knee" after total knee replacement: a pragmatic study from a single-centre cohort[J]. Joint Bone Spine, 2015, 82(3): 177-181.
[28]	宋志颖，高冲，陈宝安. 天气对骨关节炎疼痛的影响[J]. 现代医学，2019, 47(9): 1156-1160.
[29]	Shannak O, Palan J, Esler C. A regional registry study of 216 patients investigating if patient satisfaction after total knee arthroplasty changes over a time period of five to 20 years[J]. Knee, 2017, 24(4): 824-828.

		满意组	不满意组	统计值	P值
例数		475	62
随访时间[个月，(±s)]		63.6±13.1	65.7±12.0	t＝-1.198	0.232
手术时间[h，(±s)]		1.7±0.5	1.9±0.6	t＝-1.938	0.053
病史时间[年，(±s)]		10.6±7.6	10.8±8.3	t＝-0.175	0.861
住院时间[d，(±s)]		22.2±7.3	24.0±7.3	t＝-1.888	0.060
HSS(±s)		86.9±6.8	73.4±10.7	t＝13.861	<0.001
WOMAC(±s)		56.2±22.6	95.9±35.8	t＝-12.390	<0.001
	疼痛	9.6±6.0	19.7±10.0	t＝-11.410	<0.001
	僵硬	6.0±2.2	7.9±3.4	t＝-6.281	<0.001
	关节功能	40.8±19.0	68.3±25.8	t＝-10.210	<0.001
性别(例)				χ²＝0.077^a	0.782^a
	男	100	14
	女	375	48
年龄(例)				χ²＝7.470	0.004^a
	≥70岁	260	46
	<70岁	215	16
BMI(例)				χ²＝14.412	<0.001^a
	超重组	263	50
	正常组	212	12
屈曲畸形(例)				χ²＝2.303	0.129^a
	轻度	393	56
	中度	82	6
心脑血管疾病(例)				χ²＝4.275	0.039^a
	有	248	41
	无	227	21
糖尿病(例)				χ²＝0.832	0.362^a
	有	57	5
	无	418	57
单双侧(例)				χ²＝0.125	0.723^a
	单侧	311	42
	双侧	164	20
诊断(例)				χ²＝0.721	0.426^b
	OA	443	56
	其他	32	6
教育水平(例)				χ²＝3.801	0.149^a
	文盲	170	16
	小学、中学	229	38
	高中以上	76	8
假体厂家(例)				χ²＝1.728^a	0.189^a
	史赛克	249	27
	强生	226	35
定期复诊(例)				χ²＝39.725	<0.001^a
	是	100	36
	否	375	26
术后跪姿(例)				χ²＝0.315	0.575^b
	是	10	2
	否	465	60

		满意组	不满意组	统计值	P值
例数		475	62
随访时间[个月，(±s)]		63.6±13.1	65.7±12.0	t＝-1.198	0.232
手术时间[h，(±s)]		1.7±0.5	1.9±0.6	t＝-1.938	0.053
病史时间[年，(±s)]		10.6±7.6	10.8±8.3	t＝-0.175	0.861
住院时间[d，(±s)]		22.2±7.3	24.0±7.3	t＝-1.888	0.060
HSS(±s)		86.9±6.8	73.4±10.7	t＝13.861	<0.001
WOMAC(±s)		56.2±22.6	95.9±35.8	t＝-12.390	<0.001
	疼痛	9.6±6.0	19.7±10.0	t＝-11.410	<0.001
	僵硬	6.0±2.2	7.9±3.4	t＝-6.281	<0.001
	关节功能	40.8±19.0	68.3±25.8	t＝-10.210	<0.001
性别(例)				χ²＝0.077^a	0.782^a
	男	100	14
	女	375	48
年龄(例)				χ²＝7.470	0.004^a
	≥70岁	260	46
	<70岁	215	16
BMI(例)				χ²＝14.412	<0.001^a
	超重组	263	50
	正常组	212	12
屈曲畸形(例)				χ²＝2.303	0.129^a
	轻度	393	56
	中度	82	6
心脑血管疾病(例)				χ²＝4.275	0.039^a
	有	248	41
	无	227	21
糖尿病(例)				χ²＝0.832	0.362^a
	有	57	5
	无	418	57
单双侧(例)				χ²＝0.125	0.723^a
	单侧	311	42
	双侧	164	20
诊断(例)				χ²＝0.721	0.426^b
	OA	443	56
	其他	32	6
教育水平(例)				χ²＝3.801	0.149^a
	文盲	170	16
	小学、中学	229	38
	高中以上	76	8
假体厂家(例)				χ²＝1.728^a	0.189^a
	史赛克	249	27
	强生	226	35
定期复诊(例)				χ²＝39.725	<0.001^a
	是	100	36
	否	375	26
术后跪姿(例)				χ²＝0.315	0.575^b
	是	10	2
	否	465	60

相关因素	b	SE	P值	wald	OR值	OR值的95% CI
年龄	1.084	0.404	0.009	6.733	2.851	(1.292，6.289)
HSS	-1.962	0.384	<0.001	26.122	0.141	(0.066，0.298)
不适感	2.959	0.646	<0.001	19.275	19.275	(5.429，68.434)
WOMAC评分≥120	2.575	0.776	0.001	13.128	13.128	(2.868，60.094)
WOMAC评分80～120	2.277	0.764	0.003	9.749	2.182	(2.182，43.562)

相关因素	b	SE	P值	wald	OR值	OR值的95% CI
年龄	1.084	0.404	0.009	6.733	2.851	(1.292，6.289)
HSS	-1.962	0.384	<0.001	26.122	0.141	(0.066，0.298)
不适感	2.959	0.646	<0.001	19.275	19.275	(5.429，68.434)
WOMAC评分≥120	2.575	0.776	0.001	13.128	13.128	(2.868，60.094)
WOMAC评分80～120	2.277	0.764	0.003	9.749	2.182	(2.182，43.562)

Please choose a citation manager

Content to export