Cross-sectional study of 1703 primary TKAs from the Ontario Joint Replacement Registry. Asked whether contemporary implants improved satisfaction over historic rates, and which preoperative and postoperative factors predicted dissatisfaction at one year. Level II prognostic study.
A 19% dissatisfaction rate after TKA has persisted across decades and implant generations — this study of 1703 patients proved contemporary hardware did not change it. The dominant driver was unmet expectations, with a 10.7× effect size that no surgical variable approaches. This is why structured preoperative expectation-setting has become a core component of modern TKA shared decision-making.
When counseling a patient preoperatively, be specific: stair climbing and car transfers are where satisfaction is lowest (72% and 70%). The gap between what a patient imagines and what they experience at those moments is where dissatisfaction is born.
Flag patients with preoperative rest pain before booking the case. An OR of 2.4 for dissatisfaction means this group requires honest counseling about residual symptoms, not reassurance.
Cross-sectional study of 1703 primary TKAs from the Ontario Joint Replacement Registry. Asked whether contemporary implants improved satisfaction over historic rates, and which preoperative and postoperative factors predicted dissatisfaction at one year. Level II prognostic study.
A 19% dissatisfaction rate after TKA has persisted across decades and implant generations — this study of 1703 patients proved contemporary hardware did not change it. The dominant driver was unmet expectations, with a 10.7× effect size that no surgical variable approaches. This is why structured preoperative expectation-setting has become a core component of modern TKA shared decision-making.
When counseling a patient preoperatively, be specific: stair climbing and car transfers are where satisfaction is lowest (72% and 70%). The gap between what a patient imagines and what they experience at those moments is where dissatisfaction is born.
Flag patients with preoperative rest pain before booking the case. An OR of 2.4 for dissatisfaction means this group requires honest counseling about residual symptoms, not reassurance.