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Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study.

ABSTRACT: BACKGROUND:Despite the continued improvement in the surgical techniques during primary total knee arthroplasty (TKA), literatures indicate that up to 10 to 20% patients are not satisfied with their outcomes. Psychological factors in this dissatisfaction are yet to be clearly identified. The aim of this study is to develop a method to assess whether the patient's current mental state is suitable enough to accept a TKA surgery. METHODS:Preoperative demographic and clinical data of 532 patients who underwent TKA were prospectively obtained from January 2012 until December 2016. We recorded the scores evaluated by SF-36 questionnaire and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperatively and 1?year postoperatively. Preoperative Life Satisfaction Rating (LSR) is emphatically evaluated. RESULTS:Poor preoperative score of LSR was a significant predictor of dissatisfaction after TKA. Patients with low LSR reported significant pain and stiffness, although there was no remarkable effect on functionality of the replaced joint. The results also showed that age and BMI were not strong predictors of satisfaction in TKA. CONCLUSION:Our outcomes can help clinicians evaluate whether a patient's current mental status is favorable for TKA. If patients have extreme low scores of LSR (less than 10), a psychological intervention should be recommended for better satisfaction following a TKA surgery. This would also allow surgeons to individually assess the risks and benefits of surgery.

SUBMITTER: Liu K

PROVIDER: S-EPMC7160936 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study.

Liu Kaiyuan K Yang Dong D Zan Pengfei P Fan Aoyuan A Zheng Zhi Z Jiang Wenwei W Li Guodong G

Journal of orthopaedic surgery and research 20200415 1

<h4>Background</h4>Despite the continued improvement in the surgical techniques during primary total knee arthroplasty (TKA), literatures indicate that up to 10 to 20% patients are not satisfied with their outcomes. Psychological factors in this dissatisfaction are yet to be clearly identified. The aim of this study is to develop a method to assess whether the patient's current mental state is suitable enough to accept a TKA surgery.<h4>Methods</h4>Preoperative demographic and clinical data of 5 ...[more]

PMID: 32293485

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Project description:IntroductionThe objective of this study was to assess the number and magnitude of preoperative expectations and to correlate them with the degree of satisfaction expressed one year after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), in patients with severe and painful osteoarthritis (OA).Materials and methodsPreoperative expectations (within 20 days prior to surgery) and postoperative satisfaction (one year after the intervention) were measured using the previously validated French version of the Hospital for Special Surgery Hip or Knee Replacement Expectations Survey. Postoperative satisfaction was measured using a specific scale, following the same methodology as that used for the assessment of expectations. Prediction of the satisfaction of the patients was performed using multivariate linear regression modelling.ResultsA total of 138 patients (80 THA and 58 TKA) completed the two parts of the study. The expectations score (mean ± SD) (range 0-100) was 72.58 ± 12.63 before THA and 69.10 ± 13.72 before TKA (p = 0.13). The number of expectations expressed was 14.34 ± 1.32 (out of a potential maximum of 18) before THA and 14.70 ± 2.29 (out of a potential maximum of 19) before TKA. After 1 year, THA generated a significantly higher degree of satisfaction compared to TKA (69.70 ± 14.46 v 60.44 ± 17.54, p<0.001) (range 0-100). The pre-operative expectations score was the single best positive predictor of the post-surgery satisfaction assessment both for TKA and THA.ConclusionPatients undergoing total joint arthroplasty for end-stage OA have a high level of expectations, before both THA and TKA. While both types of interventions significantly improve essential and non-essential activities, the rate of satisfaction is significantly greater post THA. Preoperative expectations are a major contributor to the final degree of satisfaction, one year after surgery. These results re-emphasize the need for an optimal preoperative interaction between health care providers and patients, to allow patients a chance to foresee a reasonable outcome after TJA.

Project description:ObjectiveTo compare the blood loss, transfusion rates and complications between the aspirin and non-aspirin group in unilateral and bilateral total knee arthroplasties (TKAs) with a nested case-control design.MethodsThe present study retrospectively selected TKA cases from the Joint Arthroplasty Database at the Peking Union Medical College Hospital from January 2014 to December 2019 following strict inclusion and exclusion criteria, and divided them into the aspirin and non-aspirin group based on the use of aspirin preoperatively. Bleeding was measured by blood loss, transfusion rate, drainage volume, hemoglobin (HGB) and hematocrit (HCT), while complications (cardiovascular events, venous thromboembolism events, cerebrovascular events and wound events) were compared between the groups. Student's unpaired t-test and Mann-Whitney U-test were used to compare the differences of continuous variables between the two groups while chi-square test and Fisher's exact test were applied in categorical variables.ResultsA total of 560 patients with unilateral TKA and 285 patients with bilateral TKA were extracted. Among these, 280 patients used aspirin preoperatively. No other differences were found in demographic and surgical characteristics between the two groups except for the proportion of coronary artery diseases (P < 0.001). For primary outcomes, there was no significant higher blood loss and transfusion rate in the aspirin group, while the drainage of aspirin group was higher than the control group in bilateral TKAs (P = 0.043). The HGB and HCT of the aspirin group was significant lower in both unilateral and bilateral TKAs at POD5 (P < 0.05). For complications, there was a lower vascular related complication rate in aspirin group after unilateral TKAs (P = 0.040), but the wound event rate in aspirin group was higher than the control group (P = 0.049).ConclusionsPreoperative use of aspirin could prevent vascular related events during the perioperative period of TKA. However, it might also increase the risk of bleeding and wound complications.

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Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study.

Publications

Preoperative low scores of Life Satisfaction Rating predicts poor outcomes after total knee arthroplasty: a prospective observational study.

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