https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607604577.pdf

The operation of the century: total hip replacement

Despite substantial advances in primary TKA, numerous studies using historic TKA implants suggest only 82% to 89% of primary TKA patients are satisfied. We reexamined this issue to determine if contemporary TKA implants might be associated with improved patient satisfaction. We performed a cross-sectional study of patient satisfaction after 1703 primary TKAs performed in the province of Ontario. Our data confirmed that approximately one in five (19%) primary TKA patients were not satisfied with the outcome. Satisfaction with pain relief varied from 72–86% and with function from 70–84% for specific activities of daily living. The strongest predictors of patient dissatisfaction after primary TKA were expectations not met (10.7× greater risk), a low 1-year WOMAC (2.5× greater risk), preoperative pain at rest (2.4× greater risk) and a postoperative complication requiring hospital readmission (1.9× greater risk). Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

/pdf/patient-satisfaction-after-total-knee-arthroplasty-who-is-154rrnrrvn.pdf

Patient Satisfaction after Total Knee Arthroplasty: Who is Satisfied and Who is Not?

A postal questionnaire was sent to 10,000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p < 0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of patient satisfaction. Differences in the rate of satisfaction were also observed in relation to age, the American Society of Anesthesiologists grade and the type of prosthesis. This study has provided data on the Oxford knee score and the expected levels of satisfaction at one year after TKR. The results should act as a benchmark of practice in the United Kingdom and provide a baseline for peer comparison between institutions.

/pdf/the-role-of-pain-and-function-in-determining-patient-4dh6hj45fp.pdf

The role of pain and function in determining patient satisfaction after total knee replacement: DATA FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND AND WALES

With improving patient outcome after joint arthroplasty, new assessment tools with increased discriminatory power especially in well-performing patients are desirable. The goal of the present study was to develop and validate a new score ("Forgotten Joint Score," or FJS) introducing a new aspect of patient-reported outcome: the patient's ability to forget the artificial joint in everyday life. After a pilot study, the FJS was validated and showed high internal consistency (Cronbach α = .95). Ceiling effects were considerably lower for the FJS (9.2%) compared with the Western Ontario and McMaster Universities subscales (16.7%-46.7%). Known-group comparisons proved the FJS to be highly discriminative in a validation sample of 243 patients. The FJS not only reflects differences between "good" and "bad" but also between "good," "very good," and "excellent" outcomes. This concise score is appealing for its more adequate measurement range and because it measures the new, promising concept of the "forgotten joint."

The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure.

Summary Health-related quality of life (HRQoL) has been more intensively studied in multiple sclerosis (MS) than in any other neurological disorder. Traditional medical models of impairment and disability are an incomplete summary of disease burden. Quality of life can be thought of as the sum of all sources of satisfaction (including anticipated sources) minus all threats (including anticipated threats). Many psychosocial factors—including coping, mood, self-efficacy, and perceived support—influence the quality of life of patients with MS more than biological variables such as weakness or extent of MRI lesions. Neuropsychiatric complications such as cognitive impairment and fatigue are also important predictors, even in those patients in the early stages of the disease. We review generic and specific HRQoL measures to help clinicians choose the most appropriate therapies. Subjective (self-report) HRQoL measures may serve to alert clinicians to areas that would otherwise be overlooked. Studies of new interventions should include an assessment of HRQoL not just impairment or disability alone.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(05)70166-6.pdf

G. Sinnema

Papers

Quality of life: patients and doctors don't always agree: a meta-analysis