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Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone A cohort study from the National Joint Registry for England and Wales

Lookup NU author(s): Paul Baker, Professor Stephen Rushton, Dr Simon Jameson, Michael Reed, Professor David Deehan

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Abstract

Pre-operative variables are increasingly being used to determine eligibility for total knee replacement (TKR). This study was undertaken to evaluate the relationships, interactions and predictive capacity of variables available pre- and post-operatively on patient satisfaction following TKR. Using nationally collected patient reported outcome measures and data from the National Joint Registry for England and Wales, we identified 22 798 patients who underwent TKR for osteoarthritis between August 2008 and September 2010. The ability of specific covariates to predict satisfaction was assessed using ordinal logistic regression and structural equational modelling. Only 4959 (22%) of 22 278 patients rated the results of their TKR as 'excellent', despite the majority (71%, n = 15 882) perceiving their knee symptoms to be much improved. The strongest predictors of satisfaction were post-operative variables. Satisfaction was significantly and positively related to the perception of symptom improvement (operative success) and the post-operative EuroQol-5D score. While also significant within the models pre-operative variables were less important and had a minimal influence upon post-operative satisfaction. The most robust predictions of satisfaction occurred only when both pre-and post-operative variables were considered together. These findings question the appropriateness of restricting access to care based on arbitrary pre-operative thresholds as these factors have little bearing on postoperative satisfaction.


Publication metadata

Author(s): Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Bone & Joint Journal

Year: 2013

Volume: 95B

Issue: 10

Pages: 1359-1365

Print publication date: 01/10/2013

Acceptance date: 05/06/2013

ISSN (print): 2049-4394

ISSN (electronic): 2049-4408

Publisher: British Editorial Society of Bone and Joint Surgery

URL: http://dx.doi.org/10.1302/0301-620X.95B10.32281

DOI: 10.1302/0301-620X.95B10.32281


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