In an article published in the December 2015 Journal of the American Academy of Orthopedic Surgeons, authors Adeel Husain and Gwo-Chin Lee review factors associated with realistic expectations following total knee replacement. They note that 20% of patients are, in some fashion, dissatisfied with the outcome of a well-performing total knee replacement. They note that total knee replacement has been shown to be a durable, reliable, and reproducible procedure with regard to relieving pain and improving function in patients with end-stage arthritis. They reviewed patient expectations which include pain relief, improvement in motion and, therefore, better function are universally anticipated. There are several patient factors that affect satisfaction. The severity of knee arthritis affects the outcome in that patients with less severely involved knees tend to have poor outcomes after surgery. Other factors noted to impact patient satisfaction include weight, narcotic use, and medical comorbidities. The patient’s mental health will also impact the level of satisfaction following knee replacement.
It is important when we as joint replacement surgeons interact with patients that realistic expectations be set. It is well known that improvement will occur for over 12 months after knee replacement. Some patients take as long as two years to fully recover from a knee replacement. The drivers of patient satisfaction after knee replacement are complex and multifactorial, though unmet expectations have been shown to be a significant source of dissatisfaction. Common causes of dissatisfaction, including residual pain, stiffness, and failure to return to high levels of function, can occur following a routine, well-done total knee surgery. To reduce this, it is important to make sure patient selection and management of expectations are appropriately carried out prior to knee replacement surgery.