Prospective cohort study of 253 patients completing a validated Knee Function Questionnaire at minimum 1 year after primary unilateral TKA. The central question: which factors — functional outcomes, residual symptoms, or fulfillment of preoperative expectations — most strongly predict patient satisfaction, and what is their relative weight?
When a patient asks what to expect from TKA, how you answer that question is as important as the surgery itself. This paper established that satisfaction is governed by whether the outcome matches what the patient imagined beforehand — not by the knee's objective functional performance.
In clinic, this means preoperative counseling must do more than quote complication rates. Specifically address activity expectations: patients who enter surgery expecting to return to their pre-arthritis activity level are the ones most likely to be dissatisfied, even after a technically perfect TKA.
Postoperatively, residual stiffness is your most actionable target. Stiffness more than once per week carries the strongest independent association with dissatisfaction (OR 0.17). Aggressive early range-of-motion protocols and prompt management of stiffness are not just rehabilitation details. They are satisfaction drivers.
The finding that dissatisfied patients without residual symptoms are functionally indistinguishable from satisfied patients confirms that some dissatisfaction is purely expectation-driven and cannot be fixed with revision surgery. Recognizing this preoperatively. Particularly in younger, higher-expectation patients. Is essential before offering reoperation.
Prospective cohort study of 253 patients completing a validated Knee Function Questionnaire at minimum 1 year after primary unilateral TKA. The central question: which factors — functional outcomes, residual symptoms, or fulfillment of preoperative expectations — most strongly predict patient satisfaction, and what is their relative weight?
When a patient asks what to expect from TKA, how you answer that question is as important as the surgery itself. This paper established that satisfaction is governed by whether the outcome matches what the patient imagined beforehand — not by the knee's objective functional performance.
In clinic, this means preoperative counseling must do more than quote complication rates. Specifically address activity expectations: patients who enter surgery expecting to return to their pre-arthritis activity level are the ones most likely to be dissatisfied, even after a technically perfect TKA.
Postoperatively, residual stiffness is your most actionable target. Stiffness more than once per week carries the strongest independent association with dissatisfaction (OR 0.17). Aggressive early range-of-motion protocols and prompt management of stiffness are not just rehabilitation details. They are satisfaction drivers.
The finding that dissatisfied patients without residual symptoms are functionally indistinguishable from satisfied patients confirms that some dissatisfaction is purely expectation-driven and cannot be fixed with revision surgery. Recognizing this preoperatively. Particularly in younger, higher-expectation patients. Is essential before offering reoperation.