Abstract
Background
Total knee arthroplasty (TKA) is a routine, cost-effective treatment for end-stage arthritis. While the evidence for good-to-excellent patient-reported outcomes and objective clinical data is present, approximately 20% of patients continue to be dissatisfied with results of their surgery. Dissatisfaction is strongly correlated with unmet patient expectations, and these patients may experience a higher cost of care due to recurring office and emergency visits. Therefore, this survey asked a large group of United States (U.S) and international surgeons to prioritize areas of opportunity in primary TKA. Specifically, we compared surgeon responses regarding: 1) the top 5 areas needing improvement; which were stratified by: 2) surgeons' years of experience; and 3) surgical case volume.
Methods
A total of 418 orthopaedic surgeons were surveyed. Two hundred U.S. surgeons and 218 international surgeons participated from 7 different countries including: The United Kingdom (40), France (40), Germany (43), Italy (40), Spain (38), and Australia (17). To participate, surgeons had to be board certified, in practice for 2 years, spend 60% of their time in clinical practice, and perform a minimum of 25 joint arthroplasties per year. Surgeons were asked to choose the top 5 areas of improvement for TKA from a list of 17 attributes including clinical and functional outcomes, procedural workflow and economic variables. Surgeons were able to specify additional options if needed. Results were stratified by annual case volume (25 to 50; 51 to 100; greater than 100 cases) and years of experience (1 to 10; 11 to 20; greater than 20). Single-tail proportion tests were used to compare results between cohorts, where an alpha of 0.05 was set as significant.
Results
The most frequently identified opportunity in both groups was functional outcomes, selected by 63% of U.S. surgeons (p=0.001) compared to 71% of international surgeons (p=0.002). In the U.S. cohort, this was followed by cost (47%), which was not identified in the top 5 choices for international surgeons. Cost was followed by implant survivorship (45%), patient satisfaction (42%), and accuracy/precision (39%). In the international cohort, implant survivorship (57%), dynamic joint balancing (40%), accuracy/precision (39%), and patient satisfaction rates (35%) were noted. When stratified by years of experience and case volume, the top area for improvement remained functional outcomes for U.S. and International groups.
Conclusion
The responses in the international survey demonstrate that functional outcomes, implant survivorship and costs had greater perceived potential for improvement, compared to the specific targeting of post-operative patient satisfaction. Functional outcomes remained a top area for improvement, regardless of years of experience or case volume. As a result, enhancing functional outcomes and implant survivorship may ultimately address patient satisfaction, by more consistently meeting patient expectations. These results serve as baseline data to help guide future improvements in knee arthroplasty.
