Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Knee Surg Sports Traumatol Arthrosc. 2023 Sep;31(9):3755-3764. doi: 10.1007/s00167-022-07301-y. Epub 2023 Feb 6.
Patient satisfaction with the results of their total knee arthroplasty (TKA) is one of the primary goals of this elective procedure. Furthermore, the association between the fulfilment of patients' expectations and their satisfaction is well known. The aim of this study was to identify the key expectations of patients awaiting a TKA, evaluate their fulfilment, and compare the outcomes between very and not fully satisfied patients.
A prospective cohort study of patients with knee OA scheduled for primary TKA was performed. Pre- and one-year postoperatively patient-reported outcome measures (PROMs) were assessed. Expectations and their fulfilment were evaluated via a questionnaire encompassing 31 expectations. Preoperatively, expectations were indicated as mandatory, desirable and not important. Postoperatively, fulfilment was rated as exceeded, fulfilled, partially or not fulfilled, and not applicable. Satisfaction with the results of TKA was measured with a numeric rating scale (NRS) of 0-10. Discrimination between not fully satisfied and very satisfied patients was set at ≥ 8, as has been proposed recently. To identify independent predictors of this discrimination, a multivariate logistic regression analysis was performed.
Complete data sets of 352 patients were analysed. A set of 17 key expectations was identified. Relief of knee pain was fulfilled the most, and improvement of physical function was fulfilled the least. When asked about overall fulfilled expectations, 40% of patients rated them as exceeded, 34% as fulfilled and 26% as less fulfilled than expected. Not fully satisfied patients showed significantly lower PROMs pre- and postoperatively and less fulfilled key expectations. Higher numbers of exceeded and fulfilled mandatory expectations, higher overall fulfilment and better range of motion (ROM) were significant predictors for satisfaction ≥ 8.
Patients' expectations of TKA outcomes were high with equal emphasis on knee-related and general health-related aspects. Their fulfilment was positively associated with satisfaction. Surgeons should ask patients about mandatory expectations for successful TKA and counsel them about the likelihood of their fulfilment to avoid unrealistic expectations.
II.
患者对全膝关节置换术（TKA）结果的满意度是该选择性手术的主要目标之一。此外，患者期望的满足与他们的满意度之间存在关联是众所周知的。本研究的目的是确定等待 TKA 的患者的关键期望，评估他们的期望满足情况，并比较非常满意和不完全满意患者的结果。
对计划进行初次 TKA 的膝关节骨关节炎患者进行前瞻性队列研究。在术前和术后一年评估患者报告的结果测量（PROM）。通过包含 31 个期望的问卷评估期望及其满足情况。术前，期望被标记为必须、期望和不重要。术后，满足情况被评为超过、满足、部分满足或不满足和不适用。使用 0-10 的数字评分量表（NRS）测量对 TKA 结果的满意度。将不完全满意和非常满意患者之间的差异设定为≥8，这是最近提出的。为了确定这种差异的独立预测因素，进行了多变量逻辑回归分析。
分析了 352 例患者的完整数据集。确定了一组 17 个关键期望。膝关节疼痛缓解的满足度最高，身体功能的改善满足度最低。当被问及总体期望满足情况时，40%的患者认为超过了期望，34%的患者认为满足了期望，26%的患者认为满足了期望。不完全满意的患者术前和术后的 PROM 明显较低，关键期望的满足度也较低。更高的超过和满足强制性期望的数量、更高的总体满足度和更好的活动范围（ROM）是满意度≥8 的显著预测因素。
患者对 TKA 结果的期望很高，对膝关节相关和一般健康相关方面的重视程度相等。他们的期望满足与满意度呈正相关。外科医生应询问患者对成功 TKA 的强制性期望，并就其满足的可能性向他们提供咨询，以避免不切实际的期望。
II 级。
