Today's News

Saturday, February 15, 1997

Arthritis patients satisfied with surgery outcomes

A study of 258 knee replacement surgeries in arthritis patients, that combined demographic and social predictors with clinical scores found that 89 percent of the patients who had primary knee replacements and 83 percent who had knee revision surgery were either satisfied or enthusiastic about their results.

The results were based on a model presented Friday in scientific paper 266 by David A. Heck, MD, professor of orthopaedics, Indiana University School of Medicine, Indianapolis. Dr. Heck said basic medical information and clinical scores can help explain some satisfaction levels of patients following surgery, but researchers believe extensive patient-based outcome assessments (including outside direct medical influences) can provide orthopaedic surgeons, referring physicians and patients with an even better understanding of results.

More outcome data needs to be obtained and recorded by practices in a systematic, electronic fashion, said Dr. Heck, who believes that "through this technology not only would this data model be tested, but practice styles, locations and predictive validity could be compared to improve patient health."

The study also revealed that patients who were not satisfied with their results said that they desired further pain reduction (17 percent) or increased knee motion (12 percent). Other patients wanted to walk better, return to an original pre-arthritic state or increase strength.

Sixty-four percent of the primary knees and 67 percent of the revised knees had osteoarthritis. Twenty-four percent of both groups had rheumatoid arthritis. Knee scores, general health status scores, diagnosis, types of surgery and forms of insurance were included in the data from patients, all of whom were followed for a minimum of two years.

Range of motion was the most important factor in determining satisfaction. Motivation, gender, preoperative quadricep strength and smoking contributed to the satisfaction levels of the patients. Race, education, preoperative instability, preoperative active knee extension, body mass index, postoperative pain, general health and passive knee motion measures did not significantly affect the satisfaction model.

Dr. Heck said that although the reason is unclear, his study found that insurance status contributed to the overall satisfaction with the knee replacements. "Individuals who were receiving coverage through Medicare or Medicaid had the highest levels of overall satisfaction. Patients receiving reimbursement for their health care needs through commercial forms of managed care or private insurance tended to be less satisfied.

"Health care measures including length of hospital stay, site of discharge, approval for use of rehabilitative services, out-of-pocket expenditures and other factors which may contribute to satisfaction will need to be explored in the future," Dr. Heck said.

Co-author of the study is Cynthia M. Partridge, manager of research, Indiana University School of Medicine.