Gardner Jonathan, Roman Elliott R, Bhimani Rohat, Mashni Sam J, Whitaker John E, Smith Langan S, Swiergosz Andrew, Malkani Arthur L
Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA.
University of Louisville School of Medicine, Louisville, Kentucky, USA.
Bone Jt Open. 2024 Sep 12;5(9):758-765. doi: 10.1302/2633-1462.59.BJO-2024-0099.R1.
Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction.
This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups.
Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction.
The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.
据报道，使用基于手动夹具的器械进行初次全膝关节置换术（TKA）后患者的不满意率高达30%。机器人辅助全膝关节置换术（RA-TKA）已越来越多地被使用，以努力改善患者的治疗效果，然而，关于RA-TKA后患者满意度的文献却很少。本研究旨在确定RA-TKA后不满意患者的发生率，并确定与更高程度不满意相关的因素。
这是一项对2016年10月至2020年9月期间接受初次TKA且至少随访两年的674例患者的回顾性研究。采用五点李克特满意度评分将患者分为两组：A组为非常不满意、不满意或中立（李克特评分1至3）的患者，B组为满意或非常满意（李克特评分4至5）的患者。比较两组患者的人口统计学数据以及术前和术后患者报告的结局指标。
总体而言，A组有45例患者（6.7%），B组有629例患者（93.3%）。A组（与B组相比）男性比例更高（p = 0.008）、术前长期使用阿片类药物（p < 0.001）、术前使用精神药物（p = 0.01）、既往有前交叉韧带（ACL）重建史（p < 0.001）以及术前有症状性腰椎疾病（p = 0.004）。A组患者也更年轻（p = 0.023）。多变量分析显示，术前使用阿片类药物（p = 0.012）、既往ACL重建史（p = 0.038）、男性（p = 0.006）以及术前使用精神药物（p = 0.001）是患者不满意的独立预测因素。
使用RA-TKA显示出较高的患者满意度（674例中的629例，93.3%）。RA-TKA后不满意患者的人口统计学特征包括：男性、长期使用阿片类药物、长期使用精神药物以及既往有ACL重建史。这些组中的患者应在术前进行识别，并鉴于其合并症对他们进行关于现实期望的教育。
