This systematic review examined how patient satisfaction is measured and reported after total knee replacement for osteoarthritis. It pooled 208 studies covering 95,560 patients to assess the quality of the evidence and identify predictors of satisfaction and dissatisfaction. The goal was to understand why a meaningful minority of patients remain unhappy despite a technically successful operation.
When counseling a TKR candidate, the two levers most under your control are expectations and mental health, not just the technical operation.
One in five patients is dissatisfied even after a well-done knee, and the strongest driver of that dissatisfaction is a mismatch between expected and actual outcome. Bourne's data showed unmet expectations raised dissatisfaction risk 10.7-fold, so a structured preoperative conversation about realistic function and residual symptoms is a concrete intervention.
Screen for anxiety and depression before surgery. The paper is explicit that these patients should not be denied TKR, but their mental health should be identified and addressed, and used to frame counseling. Recognize that persistent postoperative pain is the leading postoperative reason patients stay unhappy, so setting expectations about pain is worthwhile.
For boards and practice, know that satisfaction reporting itself is unstandardized. Only 13% of studies use validated tools, with the 2011 Knee Society Score being the preferred instrument because it captures both expectations and satisfaction.
This systematic review examined how patient satisfaction is measured and reported after total knee replacement for osteoarthritis. It pooled 208 studies covering 95,560 patients to assess the quality of the evidence and identify predictors of satisfaction and dissatisfaction. The goal was to understand why a meaningful minority of patients remain unhappy despite a technically successful operation.
When counseling a TKR candidate, the two levers most under your control are expectations and mental health, not just the technical operation.
One in five patients is dissatisfied even after a well-done knee, and the strongest driver of that dissatisfaction is a mismatch between expected and actual outcome. Bourne's data showed unmet expectations raised dissatisfaction risk 10.7-fold, so a structured preoperative conversation about realistic function and residual symptoms is a concrete intervention.
Screen for anxiety and depression before surgery. The paper is explicit that these patients should not be denied TKR, but their mental health should be identified and addressed, and used to frame counseling. Recognize that persistent postoperative pain is the leading postoperative reason patients stay unhappy, so setting expectations about pain is worthwhile.
For boards and practice, know that satisfaction reporting itself is unstandardized. Only 13% of studies use validated tools, with the 2011 Knee Society Score being the preferred instrument because it captures both expectations and satisfaction.