Who's Happy with Knee Surgery?

Mild osteoarthritis knee replacement patients likelier to be unhappy with procedure

(RxWiki News) While less than 5 percent of knee implant recipients go back under the knife for adjustments, certain patients are more unhappy with the results than others.

A recent study showed that 85 percent of knee replacement patients overall were satisfied with the results of their surgery. However, results also showed that patients with moderate to mild osteoarthritis were at least two and a half times more likely to be dissatisfied with the procedure.

This elevated risk of dissatisfaction should be included in pre-operative information given to patients considering total knee arthroplasty (TKA) surgery, according to researchers.

"Ask an orthopedic surgeon about TKA risks."

Researchers, led by Christoph Schnurr, MD, from the LVR Clinic of Orthopaedic Surgery in Germany, wanted to identify who was more at risk of being dissatisfied with their new knee before going under the knife.

The study included 996 patients undergoing total knee arthroplasty between January 2006 and January 2010. Researchers tracked patients between one and six years after surgery.

Researchers noted patients' age, gender, arthritis diagnosis and range of motion in the knee prior to surgery.

They also tracked the type of implant, implant alignment technique and X-rays before and after the procedure.

The chance of being dissatisfied increased two and half to three times among patients with moderate osteoarthritis compared to patients without the condition, researchers found.

About 15 percent of the patients reported being unsatisfied with their new knee. The rest were satisfied.

Osteoarthritis severity and patients' age influenced their operation satisfaction. The time after the operation did not affect satisfaction levels.

"In conclusion, our study showed an elevated risk for dissatisfaction after TKA in cases of mild or moderate osteoarthritis severity…" researchers wrote in their report.

"Those higher dissatisfaction rates are especially remarkable, as a substantial number of TKAs were implanted before development of severe osteoarthritis," they wrote.

The information patients receive prior to the operation should include the elevated dissatisfaction risk in individuals with mild or moderate osteoarthritis, according to researchers.

Dan Clearfield, DO, MS, a primary care sports medicine physician and dailyRx Contributing Expert, recommends that knee surgery patients take glucosamine, chondroitin and MSM (methylsulfonylmethane) for their joints.

"Many patients who undergo total knee arthroplasty are dissatisfied as they were hoping for less pain and more function out of the joint after it was replaced," he said.

"As a primary care sports medicine physician, I try to ensure that my patients have absolutely exhausted conservative means of treatment prior to undergoing a TKA."

Knee load is reduced four-fold in daily activities for every kilogram of weight a patient loses, according to Dr. Clearfield.

To decrease arthritic pain and increase strength and flexibility, he also recommends that patients walk 1,000 steps in 10 minutes and work their way up to 3,000 steps in 30 minutes.

If patients want to do other activities besides walking, Dr. Clearfield suggests doing tai chi, swimming, aquatic aerobics, biking, elliptical, and yoga.

The researchers noted that satisfaction was measured at different times after the operation.

They also did not measure knee function using a standardized score system, though researchers said that knee function can't be measured as satisfaction.

The study was published online March 23 in the journal International Orthopaedics. No conflicts of interest were declared.

Review Date: 
April 5, 2013