Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Research article

Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study

Authors: Aamir Mahdi, Mia Svantesson, Per Wretenberg, Maria Hälleberg-Nyman

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate.

Methods

Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment 1 year after total knee arthroplasty.

Results

The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs.

Conclusion

Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.
Appendix
Available only for authorised users
Literature
1.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.CrossRef
2.
SKAR. The Swedish knee arthroplasty register – annual report 2016 – PART I: Annual report. Lund, Sweden OdL: University of Lund; 2016.
3.
Ali A, Lindstrand A, Sundberg M, Flivik G. Preoperative anxiety and depression correlate with dissatisfaction after Total knee Arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up. J Arthroplast. 2017;32(3):767–70.CrossRef
4.
Bletterman AN, de Geest-Vrolijk ME, Vriezekolk JE. Nijhuis-van der Sanden MW, van Meeteren NL, Hoogeboom TJ. Preoperative psychosocial factors predicting patient's functional recovery after total knee or total hip arthroplasty: a systematic review. Clin Rehabil. 2017;269215517730669:512-25.PubMedCrossRef
5.
Bozic KJ, Lau E, Ong K, Chan V, Kurtz S, Vail TP, et al. Risk factors for early revision after primary TKA in Medicare patients. Clin Orthop Relat Res. 2014;472(1):232–7.PubMedCrossRef
6.
Browne JA, Sandberg BF, D'Apuzzo MR, Novicoff WM. Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study. J Arthroplast. 2014;29(3):481–3.CrossRef
7.
Gibon E, Goodman MJ, Goodman SB. Patient satisfaction after Total knee Arthroplasty: a realistic or imaginary goal? Orthop Clin North Am. 2017;48(4):421–31.PubMedCrossRef
8.
Greene KA, Harwin SF. Maximizing patient satisfaction and functional results after total knee arthroplasty. J Knee Surg. 2011;24(1):19–24.PubMedCrossRef
9.
10.
Lostak J, Gallo J, Zapletalova J. Patient satisfaction after Total knee Arthroplasty. Analysis of pre-operative and Peri-operative parameters influencing results in 826 patients. Acta Chir Orthop Traumatol Cechoslov. 2016;83(2):94–101.
11.
Schnurr C, Jarrous M, Gudden I, Eysel P, Konig DP. Pre-operative arthritis severity as a predictor for total knee arthroplasty patients' satisfaction. Int Orthop. 2013;37(7):1257–61.PubMedPubMedCentralCrossRef
12.
Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg (Br). 2012;94(7):974–81.CrossRef
13.
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71(3):262–7.PubMedCrossRef
14.
Robertsson O, Dunbar MJ. Patient satisfaction compared with general health and disease-specific questionnaires in knee arthroplasty patients. J Arthroplast. 2001;16(4):476–82.CrossRef
15.
Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I, et al. Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8-13 years of followup. Acta Orthop. 2014;85(3):229–33.PubMedPubMedCentralCrossRef
16.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, et al. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.CrossRef
17.
Clode NJ, Perry MA, Wulff L. Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty? Int J Orthop Trauma Nurs. 2018;30:14–9.PubMedCrossRef
18.
Eschalier B, Descamps S, Pereira B, Vaillant-Roussel H, Girard G, Boisgard S, et al. Randomized blinded trial of standardized written patient information before total knee arthroplasty. PLoS One. 2017;12(7):e0178358.PubMedPubMedCentralCrossRef
19.
Filbay SR, Judge A, Delmestri A, Arden NK. Evaluating Patients' Expectations From a Novel Patient-Centered Perspective Predicts Knee Arthroplasty Outcome. J Arthroplast. 2018;33(7):2146–52 e4.CrossRef
20.
Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C. Association of Depression with 90-day hospital readmission after Total joint Arthroplasty. J Arthroplast. 2016;31(11):2385–8.CrossRef
21.
Harris IA, Harris AM, Naylor JM, Adie S, Mittal R, Dao AT. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplast. 2013;28(5):722–7.CrossRef
22.
Hasegawa M, Naito Y, Yamaguchi T, Wakabayashi H, Sudo A. Factors contributing to patient satisfaction and expectations following computer-assisted Total knee Arthroplasty. J Knee Surg. 2018;31(5):448–52.PubMedCrossRef
23.
Jacobson AF, Myerscough RP, Delambo K, Fleming E, Huddleston AM, Bright N, et al. Patients' perspectives on total knee replacement. Am J Nurs. 2008;108(5):54–63 quiz −4.PubMedCrossRef
24.
Jain D, Nguyen LL, Bendich I, Nguyen LL, Lewis CG, Huddleston JI, et al. Higher patient expectations predict higher patient-reported outcomes, but not satisfaction, in Total knee Arthroplasty patients: a prospective multicenter study. J Arthroplast. 2017;32(9s):S166–s70.CrossRef
25.
Khatib Y, Madan A, Naylor JM, Harris IA. Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res. 2015;473(8):2630–8.PubMedPubMedCentralCrossRef
26.
Klement MR, Nickel BT, Penrose CT, Bala A, Green CL, Wellman SS, et al. Psychiatric disorders increase complication rate after primary total knee arthroplasty. Knee. 2016;23(5):883–6.PubMedCrossRef
27.
Lingard EA, Katz JN, Wright EA, Sledge CB. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004;86-a(10):2179–86.CrossRef
28.
Neuprez A, Delcour JP, Fatemi F, Gillet P, Crielaard JM, Bruyere O, et al. Patients' expectations impact their satisfaction following Total hip or knee Arthroplasty. PLoS One. 2016;11(12):e0167911.PubMedPubMedCentralCrossRef
29.
Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop. 2009;80(1):55–61.PubMedPubMedCentralCrossRef
30.
Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51(6):428–36.PubMedPubMedCentral
31.
Tilbury C, Haanstra TM, Leichtenberg CS, Verdegaal SH, Ostelo RW, de Vet HC, et al. Unfulfilled expectations after Total hip and knee Arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplast. 2016;31(10):2139–45.CrossRef
32.
Escobar A, Gonzalez N, Quintana JM, Las Hayas C. prioritization of patients on the waiting list for hip and knee replacement: the patients' views. Gac Sanit. 2005;19(5):379–85.PubMedCrossRef
33.
Sampietro-Colom L, Espallargues M, Reina MD, Marso E, Valderas JM, Estrada MD. Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. Aten Primaria. 2004;33(2):86–94.PubMedCrossRef
34.
Szots K, Konradsen H, Solgaard S, Bogo S, Ostergaard B. Nurse-led telephone follow-up after total knee arthroplasty--content and the patients' views. J Clin Nurs. 2015;24(19–20):2890–9.PubMedCrossRef
35.
Conradsen S, Gjerseth MM, Kvangarsnes M. Patients’ experiences from an education programme ahead of orthopaedic surgery - a qualitative study. J Clin Nurs. 2016;25(19–20):2798–806.PubMedCrossRef
36.
Andersson V, Otterstrom-Rydberg E, Karlsson AK. The importance of written and verbal information on pain treatment for patients undergoing surgical interventions. Pain Manag Nurs. 2015;16(5):634–41.PubMedCrossRef
37.
Bethge M, Kohler L, Kiel J, Thren K, Gutenbrunner C. Sports Activity Following Joint Arthroplasty: Experiences and Expectations of Elderly Patients--Findings from a Qualitative Content Analysis of Guided Interviews. Rehabilitation (Stuttg). 2015;54(4):233–9.CrossRef
38.
Mahdi A, Nyman MH, Wretenberg P. How do orthopaedic surgeons inform their patients before knee arthroplasty surgery? A cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):414.PubMedPubMedCentralCrossRef
39.
Ghomrawi HMK, Mancuso CA, Dunning A. Gonzalez Della Valle a, Alexiades M, Cornell C, et al. do surgeon expectations predict clinically important improvements in WOMAC scores after THA and TKA? Clin Orthop Relat Res. 2017;475(9):2150–8.PubMedPubMedCentralCrossRef
40.
41.
42.
43.
Niki Y, Kobayashi S, Nagura T, Udagawa K, Harato K. Joint line modification in Kinematically aligned Total knee Arthroplasty improves functional activity but not patient satisfaction. J Arthroplast. 2018;33(7):2125–30.CrossRef
44.
Louw A, Diener I, Butler DS, Puentedura EJ. Preoperative education addressing postoperative pain in total joint arthroplasty: review of content and educational delivery methods. Physiother Theory Pract. 2013;29(3):175–94.PubMedCrossRef
45.
Majid N, Lee S, Plummer V. The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(1):122–33.PubMedCrossRef
46.
Bredart A, Bodson S, Le Tourneau C, Flahault C, Bonnetain F, Beaudeau A, et al. Patients' perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study. Eur J Cancer Care (Engl). 2017;26:6.CrossRef
47.
Shamai M. Therapeutic effects of qualitative research: reconstructing the experience of treatment as a by-product of qualitative evaluation. Soc Serv Rev. 2003;77(3):455–67.CrossRef
48.
Colbourne L. The culture of cancer and the therapeutic impact of qualitative research interviews. J Res Nurs. 2005;10(5):551–67.CrossRef
49.
Van Onsem S, Verstraete M, Dhont S, Zwaenepoel B, Van Der Straeten C, Victor J. Improved walking distance and range of motion predict patient satisfaction after TKA. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3272-9.PubMedCrossRef
50.
Clement ND, Bardgett M, Weir D, Holland J, Deehan DJ. Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1196–203.PubMedCrossRef
51.
Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question. Bone Joint J. 2018;100-b(6):740–8.PubMedCrossRef
52.
Castorina S, Guglielmino C, Castrogiovanni P, Szychlinska MA, Ioppolo F, Massimino P, et al. Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study. Muscles Ligaments Tendons J. 2017;7(3):504–13.PubMedCrossRef
53.
Specht K, Kjaersgaard-Andersen P, Kehlet H, Wedderkopp N, Pedersen BD. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement. Acta Orthop. 2015;86(6):702–7.PubMedPubMedCentralCrossRef
54.
Winther SB, Foss OA, Wik TS, Davis SP, Engdal M, Jessen V, et al. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop. 2015;86(1):78–85.PubMedPubMedCentralCrossRef
55.
Lutzner J, Lange T, Schmitt J, Kopkow C, Aringer M, Bohle E, et al. The S2k guideline: Indications for knee endoprosthesis : Evidence and consent-based indications for total knee arthroplasty. Orthopade. 2018;47(9):777-81.
56.
Weinberg DB, Gittell JH, Lusenhop RW, Kautz CM, Wright J. Beyond our walls: impact of patient and provider coordination across the continuum on outcomes for surgical patients. Health Serv Res. 2007;42(1 Pt 1):7–24.PubMedPubMedCentralCrossRef
57.
Lane JV, Hamilton DF, MacDonald DJ, Ellis C, Howie CR. Factors that shape the patient's hospital experience and satisfaction with lower limb arthroplasty: an exploratory thematic analysis. BMJ Open. 2016;6(5):e010871.PubMedPubMedCentralCrossRef
Metadata
Title
Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study
Authors
Aamir Mahdi
Mia Svantesson
Per Wretenberg
Maria Hälleberg-Nyman
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-3041-y

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Research article

Intensity of resistance training via self-reported history is critical in properly characterizing musculoskeletal health

Research article

Influence of extension stem length and diameter on clinical and radiographic outcomes of revision total knee arthroplasty

Research article

Association between muscle strength and depressive symptoms among Chinese female college freshmen: a cross-sectional study

Research article

Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study

Research article

Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation?

Research article

Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition