Patient dissatisfied with TKA? Check other causes

Patient dissatisfied with TKA? Check other causes

Although total knee arthroplasty (TKA) is highly successful in treating advanced osteoarthritis (OA) of the knee, not all patients who have a TKA are satisfied with their results. According to the authors of Scientific Poster P181, there may be reasons other than the TKA for patient dissatisfaction.

Previous studies have shown that more than 10 percent of patients report that they are dissatisfied after TKA surgery. Researchers assessed the level of satisfaction among 234 patients who had uncomplicated primary TKA (375 knees), using a self-administered survey mailed to the patients a minimum of one year after surgery. Patients could select from four different levels of satisfaction: enthusiastic, satisfied, noncommittal and disappointed.

Of the 195 patients (319 knees) who responded to the survey, none said they were disappointed, but 15 patients (21 knees) were noncommittal. Researchers then contacted these patients by phone and interviewed them; researchers also reviewed their medical records and radiographs, and performed a clinical examination.

Patients mentioned various reasons for their dissatisfaction, including persistent knee pain, vague knee symptoms, severe radiating pain, an inability to do high flexion activities, and “unexplained reasons.”

The analysis of the radiographs and medical records revealed that patients who were dissatisfied had no evidence of infection, loosening or significant malalignment of the replaced tibiofemoral and patellofemoral joint. However, researchers found that all of the patients who mentioned radiating pain had significant limitations of function due to intermittent caudation caused by spinal stenosis. Researchers hypothesized that their dissatisfaction might stem from the expectation that TKA would have relieved this pain.

Patients who reported persistent knee pain also had some degrees of radiating pain. The two patients who reported inability to do high flexion activity had 120 degrees of knee flexion, but their life style required frequent use of deep knee flexion activities. Three patients who did not mention the reason for their dissatisfaction had excellent clinical scores with average range of motion of 130 degrees. Researchers could not find the cause of their dissatisfaction.

In one case, a 67-year-old woman who had had bilateral TKAs for advanced OA complained of newly developed radiating pain from the gluteal lesion to the foot after TKAs. During their evaluation, researchers found increased deep tendon reflex of the lower extremity was found. The patient was referred to the department of neurology, and was diagnosed with a spinal meningioma and underwent surgical excision of the tumor.

“Pain and functional impairments caused by spine disease were found to be major problems related to patient dissatisfaction after TKA. Surgeons may need to search for other causes than the TKA to identify the reasons for patient dissatisfaction,” conclude the authors.

The research team was led by Tae Kyun Kim, MD, and included Chong Bum Chang, MD; Yeon Gwi Kang, and Sang Cheol Seong, MD, all of Seoul, Republic of Korea. Research support was provided by the Seoul National University Bundang Hospital Research Fund.

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